Background: Interstitial lung disease (ILD) is one of the important contributors for morbidity and mortality in rheumatoid arthritis (RA) patients. There is paucity of reliable published data on burden of lung disease in RA patients from Andhra Pradesh, India. Materials and methods: This was an observational study in which 88 patients were evaluated. History and clinical features, including disease-severity score, imaging, and pulmonary function tests were recorded. The data were subjected to statistical analysis. Results: The mean age was 49.4 ± 10.3 years. Females outnumbered males. Disease duration was less than 2 years in 60.2% of subjects. Respiratory complaints were noted in 12 patients. Seropositivity was noted in 59% of patients. Based on Disease Activity Score 28, high disease activity was seen in 70.5%, moderate activity in 25%, remission in 3.4%, and low activity in 1.1%. Chest radiography showed abnormalities in 4.5%. Pulmonary function tests revealed abnormalities in 23.9% of patients. High disease activity, duration of disease, and seropositivity were not significantly associated with respiratory abnormalities in our study. Conclusion: Patients with RA should be evaluated for pulmonary involvement during their routine follow-up, which can be helpful in early detection and intervention of ILD and therefore reducing morbidity and mortality.

Objective: The present study is designed to investigate the profile of different allergen sensitivities by skin prick test in patients with nasobronchial allergy (NBA). Materials and methods: A total of 130 patients of NBA were included in the study. Each NBA patient was subjected to the skin prick test with 44 allergens. Results: Out of 130 patients, 98 patients (75.4%) had both bronchial asthma and allergic rhinitis, 11 patients (8.5%) had allergic rhinitis, and 21 patients (16.2%) had bronchial asthma alone. The age of patients ranged from 12 to 60 years, with mean age 26.4 ± 10.24 years. The most common allergen came out to be insects (26.2%) followed by dust mites (20.7%), dusts (7.4%), pollens (5.9%), fungi (5.2%), danders (3.8%), and silk (2.2%). Common insect antigens were moth and mosquito (28.9%) followed by the cockroach, housefly (24.4%), and honeybee (18.9%). Common dust allergens were grain dust and house dust. Among pollens, Amaranthus spinosus and Cassia siamea (13.3%) followed by Brassica campestris (12.2%) and Holoptelea integrifolia (10%) were common. Among fungi, Aspergillus fumigatus and Aspergillus niger were common allergens. Conclusion: Common allergens in patients of NBA were identified. Allergen-specific immunotherapy can be a viable option for these patients.

Background: Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age. Although PCOS patients have a high prevalence of obstructive sleep apnea (OSA), there is limited data on sleep quality and abnormalities in sleep architecture among this patient population. We conducted a study to assess the frequency of OSA and poor sleep quality in women with PCOS and to assess any association between these sleep disorders and metabolic abnormalities. Materials and methods: An observational study of adults with PCOS (by revised Rotterdam criteria) from May 2015 to June 2017 was conducted. Patients with thyroid disorders, pre-existing depression, current pregnancy, and recent drug use (benzodiazepines, antidiabetics, antiepileptics, steroids, and androgens) were excluded. The evaluations included the following: overnight polysomnography (PSG), lipid profile, testosterone, fasting insulin, fasting glucose levels, free androgen index (FAI), and homeostatic model assessment for insulin resistance (HOMA-IR); sleep quality [Pittsburgh Sleep Quality Index (PSQI), Jenkins Sleep Scale (JSS)], daytime sleepiness and possible depression were assessed by standard questionnaires. Descriptive statistics, t-test/Mann–Whitney test, Chi-squared test/Fischer's test were used as appropriate; p <0.05 was considered statistically significant. Results: A total of 65 patients, mean age 24.3 ± 4.0 years; mean body mass index (BMI) 26.4 ± 5.3 kg/m² were included. Frequencies of sleep disorders were evaluated as follows: Obstructive sleep apnea 10.9% (7/64) [95% confidence interval (CI): 5.4–20.9%], poor sleep quality 35.0% (21/60) (95% CI: 24.2–47.6%) by JSS, 54.2% (32/59) (95% CI: 41.6–66.3%) by PSQI. The PSG indicators of sleep quality were abnormal in arousal index, 96.8% (62); %wake time, 62.5% (40); sleep latency, 40.6% (26); and sleep efficiency, 12.5% (8). Anthropometric indicators of obesity were higher in OSA vs non-OSA patients (p <0.05). The OSA patients had lower total sleep time and %N2 stage, and higher desaturation index than non-OSA patients. When patients with good and poor sleep quality were compared, poor sleepers (by JSS and PSQI) had higher depression scores; poor sleepers by JSS had a lower waist–hip ratio (p <0.05). Daytime sleepiness scores were similar in OSA and non-OSA patients, and in good and poor sleepers. Conclusion: Sleep disorders, particularly poor sleep quality, are frequent in women with PCOS. Patients should be screened for these disorders using specific questionnaires. Further research into the metabolic consequences of these sleep disorders is mandated.

Objectives: Chronic obstructive pulmonary disease (COPD) being a disease with systemic consequences necessitate the use of multidimensional indices for a comprehensive assessment of the disease's impact including the future risk of exacerbations and mortality. To study the role of dyspnea, obstruction, smoking, and exacerbation (DOSE) index as a predictor of future disease severity and its correlation with chronic obstructive pulmonary disease test (CAT) score. Measurements and results: A total of 60 inpatients with COPD exacerbations were followed up for 6 months to record the number of exacerbations of COPD. The DOSE index and CAT score were calculated after stabilization within 48 hours of admission, at 1 week, and again at 6 months. The mean difference between DOSE index score at admission and at 1 week was 1.382 ± 0.561 and at admission and at 6 months was 2.15 ± 0.988, both being statistically significant (p < 0.001). A high DOSE index score (≥4) was associated with a greater risk of 2 or more exacerbations [odds ratio (OR), 12 (3.09–46.60) and risk estimate, 3.75 (1.53–9.17)]. For the prediction of exacerbations, the area under the curve (AUC) was larger for the DOSE index (0.854) than the global initiative for chronic obstructive lung disease (GOLD) stage (0.789), p < 0.001 for both. Furthermore, DOSE index correlated significantly with the CAT score, an established health status measure, at all stages of disease severity; at the onset of exacerbation (r = 0.719, p < 0.001), after stabilization at 1 week (r = 0.736, p < 0.001) and at 6 months (r = 0.884, p < 0.001). Conclusion: The DOSE index is a simple, practical multidimensional grading tool for assessing current symptoms, health status, and future risk in COPD and acts as a guide to disease management as its component items can be modified by interventions. Its correlation with CAT, a well-known score is a novel observation, which further corroborates the validity of the DOSE index.

Introduction: Occupational exposure is an important risk factor for lung cancer in never smokers contributing to 10–15% of lung cancers. We conducted this study to evaluate the clinico-radiological and pathological profile of occupational lung cancer among patients of Employees State Insurance (ESI) Hospital, a tertiary care center. Materials and methods: This was a cross-sectional observational study conducted over 6 years on patients diagnosed with lung malignancy at ESI Hospital and Postgraduate Institute of Medical Sciences and Research (PGIMSR), Basai Darapur, New Delhi. The details regarding their clinical history including onset and progress of the disease were interviewed. Also, the details of whole life, past, and present occupational history in a chronological order were recorded for all subjects. Results: Our study included 171 patients with mean age of 58.34 ± 11.52 years and 137 (80%) men. About 80.7% of the patients had a smoking history. The most common histological type was adenocarcinoma seen in 35.09%, followed by squamous cell carcinoma (SCC) in 23.39% of patients. About 70.19% (120/171) patients had occupational exposure. The most common exposure was of polycyclic aromatic hydrocarbons (PAH) seen in 24.8% cases. Others being silica, diesel fumes, organic dust, metal fumes, etc. Fourteen patients had occupational exposure alone in the absence of smoking. Those with pure occupational exposure in the absence of smoking had a significantly lower mean age compared to the nonexposed group (52.21 ± 11.92 vs 58.65 ± 13.93, p-value = 0.017). SCC was significantly more common in the exposed group compared to the nonexposed (37/120 vs 3/51, p-value = 0.0004). Conclusion: Occupational exposure was found in 70.19% of patients with lung cancer. The occupational lung cancer manifests at an early age and is more commonly associated with squamous cell lung cancer compared to nonoccupation-related cancer.

Objective: The objective of this study was to evaluate the presence of interstitial lung disease (ILD) in rheumatoid arthritis (RA) and to determine the role of clinical, spirometry, and high-resolution computed tomography (HRCT) findings to facilitate early detection of ILD in RA. Materials and methods: This is a prospective study at a tertiary care hospital from February 2016 to June 2019. All patients satisfying the American College of Rheumatology (ACR) criteria for RA and having respiratory symptoms or signs were included. All patients had detailed history, clinical examination, laboratory evaluation, spirometry, and HRCT chest. Results: A total of 280 patients of RA with respiratory symptoms were evaluated, out of which 82 (29.29%) had pulmonary involvement. There were 70 women and 12 men. Rheumatoid factor was positive in 90.2% of patients while anti-CCP antibody was positive in 43.9%. Chest X-ray (CXR) showed bilateral haziness in 36.9%. HRCT findings revealed a usual interstitial pneumonia (UIP) pattern in 73.2% patients and 24% had an nonspecific interstitial pneumonia (NSIP) pattern. Spirometric evidence of lung involvement was present in 84.2% of these cases. 2D Echo showed pulmonary hypertension (PH) in 46.3% of patients. Conclusion: Screening for respiratory symptoms and signs is essential in the clinical evaluation of RA. CXR, HCRT chest, and spirometry can be used effectively to diagnose RA-ILD early.

Background: The recent emergence of the coronavirus disease 2019 (COVID-19) had been associated with increased reporting of invasive mucormycosis, with high morbidity and mortality rates. According to Roden et al., pulmonary mucormycosis is the second most common presentation. Various risk factors associated with pulmonary mucormycosis besides COVID-19. The purpose of this study is to analyze patients\' demographic details, associated risk factors, and clinical and radiological findings and it confirms with histopathological examination for early diagnosis and management to improve outcomes. Materials and methods: This retrospective observational study was conducted on 16 patients with pulmonary mucormycosis confirmed with histopathology with a previous history of COVID-19 infection presenting to Pandit Dindayal Upadhyay Medical College Hospital, Rajkot, Gujarat, India, during the months of April–August 2021. We evaluated the patients\' demographic details, clinical presentation, radiological findings, treatment, and outcomes. Results: We reported 16 cases with pulmonary mucormycosis; diagnosed after a mean of 36 days from the diagnosis of COVID-19. There was male predominance with a mean age of 54.5 years. Out of 16 patients, 14 (87.5%) survived, and 2 (12.5%) died during the course of treatment. The overall mortality rate was 12.5% in our study. Conclusion: The clinician should be aware of the possibility of pulmonary mucormycosis during and after the COVID-19 infection, especially in patients with underlying risk factors, and should enable early diagnosis and treatment to reduce morbidity and mortality to improve outcomes.

Background: Obstructive sleep apnea (OSA) has association with many comorbidities. Based on the postulated hypothesis from few studies, the primary objective of this study was to assess the occurrence of subclinical interstitial lung disease in moderate-to-severe OSA patients. Materials and methods: It was a prospective observational study, conducted at a tertiary care chest institute of India, 43 moderate-to-severe OSA patients diagnosed by level-I polysomnography were enrolled. All the patients underwent detailed clinical examination with high-resolution computed tomography (HRCT) chest, pulmonary function test (PFT), and serum markers MMP-1,7, SP-A, and Krebs von den Lungen-6 (KL-6). Subclinical interstitial lung disease (ILD) was identified based on the two validated measures: high-attenuation areas (HAA), defined as the percentage of imaged lung volume having computed tomography (CT) attenuation between −600 and −250 HU and interstitial lung abnormalities (ILA), defined as the presence of ground-glass, reticular abnormality, diffuse centrilobular nodularity, honeycombing, traction bronchiectasis, nonemphysematous cysts, or architectural distortion in at least 5% of nondependent portions of the lung in HRCT chest without respiratory symptoms with preserved lung function. Results: The mean age was 54.33 ± 11.5 years with 22 (51%) males. The mean apnea−hypopnea index (AHI) was 42.38 ± 27.6 with BMI >30 kg/m² in 18 (42%) patients. The subclinical ILD was diagnosed in 12 patients. The HRCT finding of ILA was seen in 12 and high-attenuation areas (HAA) in 5 patients. The serum markers were higher in subclinical ILD compared with non-ILD OSA patients, however, only the level of MMP-7 was significantly higher in subclinical ILD patients. Conclusion: It was concluded that subclinical ILD is quite common among OSA patients with HRCT findings seen in nearly 30% of cases. This supports the hypothesis that OSA may be considered as a risk factor of subclinical ILD.

Background: Continuous positive airway pressure (CPAP) is the treatment of obstructive sleep apnea (OSA). The CPAP pressure is generally estimated by manual titration or an auto-CPAP device. An alternative method involves the use of the predictive equation. There is limited study available for the Indian population. Objectives: To compare CPAP pressure obtained by mathematical formulas with auto-CPAP titration and formulation, a preliminary predictive equation from derived data to be validated with titrated CPAP. Methods and materials: A retrospective observational study was performed in 130 patients in Department of Pulmonary Medicine of our institute from April 2019 to July 2021. Detailed history, anthropometric parameters, whole-night level-II polysomnography (PSG), and CPAP titration were performed. Stepwise linear regression was applied to establish predictive equation. This equation results were compared with available other equations and autotitrated readings. Results: The mean (SD) of age, BMI, neck girth, Epworth score, lowest SPO₂ (%), and AHI was 56.72 (11.31), 33.87 (6.43), 39.7 (4.46), 17.75 (3.18), 84.65 (8.44), and 48.75 (21.09), respectively, with male–female ratio of 3:2. Mild, moderate, and severe OSA were 7 (5.4%), 18 (13.8%), and 105 (80.8%), respectively. Continuous positive airway pressure obtained from equations was in the range of 7.40–10.95 cm H₂O. Obtained readings by equations showed a comparable correlation with CPAP-titrated results (p <0.001). Conclusion: The optimum titration pressure correlates with pressure derived from the predictive equation that is predicted average therapeutic CPAP pressure = 3.98 + 0.065 (ODI) + (AHI) + 0.018 (nadir SPO₂) - 0.013 (NC).

Background: Asthma is broadly categorized as eosinophilic or noneosinophilic. Noneosinophilic asthma (NEA) can be paucigranulocytic asthma (PGA), mixed granulocytic asthma (MGA), or neutrophilic asthma (NeuA). A relationship between the cytological type of inflammation and response to treatment with inhaled corticosteroids (ICS) in asthma has been of great interest. The objective of the current study was to predict the control of asthma according to sputum inflammatory cells. Materials and methods: A total of 58 patients were evaluated. Sputum was induced and sent for cytological examination. Patients were prescribed controller and reliever medications as per the GINA guidelines. Accordingly, subjects were divided into eosinophilic, neutrophilic, mixed granulocytic, and paucigranulocytic asthma. The response to treatment was classified as poorly controlled based on ACT score. Results: Out of 58 patients, eosinophilic asthma (EA) was 24% and noneosinophilic 76% (NeuA 17%, MGA 23%, and PGA 36%). After treatment, 14 (24.13%) patients were found poorly controlled. Poor control was in 5.17% among EA and 18.97% in NEA phenotypes. Poor control was significantly higher in females, NeuA, and MGA. Peripheral eosinophilia affects control of asthma adversely. Conclusion: Pretreatment sputum analysis can predict the asthma control and steroid responsiveness. Mixed granulocytic asthma and NeuA are difficult to control, and PGA is the best responder.

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a global public health problem. The real-time reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard test for the detection of SARS-CoV-2. However, the assay requires hours to get the final results. Therefore, antigen-based rapid assays are being used extensively to reduce the time. We have evaluated the performance of the antigen-based rapid test for the detection of SARS-CoV-2 virus in comparison with RT-PCR. Materials and methods: Nasopharyngeal and throat swabs were collected from 366 suspected patients of COVID-19 visiting our institute and subjected to qualitative RT-PCR and antigen-based rapid assays to detect the presence of SARS-CoV-2 virus. The sensitivity and specificity of the antigen-based assay were calculated in comparison with RT-PCR. Results: Compared with RT-PCR, sensitivity and specificity of the antigen-based rapid assay were observed to be 70.5% and 98.6%, respectively, in comparison with RT-PCR. However, the sensitivity of antigen-based rapid assay varied significantly with decreasing viral load. The sensitivity of the rapid antigen assay was equivalent to RT-PCR (23/23, 100%) at a higher viral load (Ct value 15–20). In contrast, the antigen assay could only detect 3/21 (14.28%) samples with Ct value >30. Conclusion: The antigen-based assay could assist in the rapid screening of a large population. However, the rapid antigen assay might not detect early stages of infection represented by low viral load. Therefore, the antigen-based assay could not replace RT-PCR testing. The study reiterates that all antigen-based negative tests should be confirmed by RT-PCR.

Introduction: The basic requirements for human survival include air, food, and water; a decrease in quality of which has a deep impact on health. An increase in population with increasing globalization, industrialization, and increased energy demand has led to increased air pollution in cities world over. Multiple national programs to improve air quality have been unsuccessful. Coronavirus disease 2019 (COVID-19) pandemic-led lockdown is a large-scale experiment that is unprecedented and could not have been done at regular times. Indirect effects include cutting down emissions from industries, vehicles, and diesel generators. Materials and methods: In this ambispective observational study, we compared the air quality index (AQI) and levels of other pollutants in the two cities of Delhi and Kanpur during the period of the lockdown, the same period during the preceding year, and during the rainy season. Results: It was observed that the cities of India with notoriously polluted air, i.e., Delhi and Kanpur, had unprecedented improvement in air quality during lockdown (Delhi, AQI: 86.91 ± 32.38 vs 249.36 ± 60.25 and Kanpur, AQI: 81.60 ± 38.54 vs 137.06 ± 46.74). The improvement was even better than the preceding year's monsoon for Delhi. The AQI was comparable in both cities during the lockdown. Conclusion: The AQI was falling in the “satisfactory” range in both Delhi and Kanpur during the lockdown. This may, in turn, favorably unfold a reduction in the incidence, progression, and exacerbation of respiratory illnesses. This is an eye-opening change and calls for urgent action to maintain the same. Timely and well-framed steps should be sought; a revolutionary carbon-free and green energy economic model is much needed. Most air pollution is preventable and can be managed by humans if a stringent action plan is rolled out and implemented sternly by government agencies.

Introduction: The association between obstructive sleep apnea (OSA) and insomnia is relatively common but is underrecognized. There are important diagnostic and therapeutic implications of comorbid OSA–insomnia overlap but there is no data available from India. Objectives: (1) To find out the prevalence of insomnia among patients with OSA; (2) To compare the demographic characteristics, Epworth sleepiness scale (ESS) scores and the presence of comorbidities among patients of OSA with insomnia vs OSA without insomnia. Materials and methods: It was a prospective observational study involving 250 patients with suspected OSA. A total of 189 patients had OSA based on type I polysomnography and were further analyzed. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Results: The prevalence of insomnia among OSA was 15.34% (29/189). Overlap was seen in 22.45 and 12.86% of women and men respectively among patients with OSA. The prevalence of overlap increased with decreasing severity of obesity and OSA. Those with OSA–insomnia overlap had significantly lower ESS scores as compared to OSA without insomnia (12.31 vs 15.24; p = 0.019). A total of 10.34% (3/29) of patients of overlap had depression whereas none from OSA alone had depression. Conclusion: There is a high prevalence of insomnia among patients with OSA (15.34%), similar to findings worldwide. Insomnia is more common among women with OSA. Overlap patients have lower ESS scores and are likely to be depressed.

Introduction: Hydatid disease in humans is caused by zoonotic parasites, after accidental ingestion of food contaminated by ova of Echinococcus granulosus. Giant hydatid cyst of the lung is most commonly seen in children, but it is rare in human adults. The lung is the second most common organ affected by hydatid diseases after the liver in humans. History and radiological findings are usually helpful in diagnosing hydatid cysts, but serology can add to the diagnosis. A small pulmonary cyst may be asymptomatic; however, giant or ruptured cysts may develop fatal complications. The surgical intervention followed by pharmacological therapy is the treatment of choice for giant hydatid cysts of the lungs. Case description: Here, we present a case of giant right-side hydatid cysts, presented with complaints of dyspnea, fever, and hemoptysis. The patient was successfully managed by right thoracotomy with an uneventful postoperative course. Conclusion: Giant hydatid lung cysts can present with any respiratory symptoms with fatal outcomes. Surgery followed by pharmacotherapy is the treatment of choice for giant pulmonary hydatid cysts.

Lung cyst is an atypical computed tomography (CT) thorax finding in COVID-19 pneumonia. Cyst in COVID-19 may result independent of mechanical ventilation. The cyst may rupture causing pneumomediastinum or pneumothorax or may get secondarily infected resulting in an adverse outcome in patients. Here, we describe the clinical characteristics and outcomes of 19 patients with COVID-19 pneumonia with lung cysts detected in CT thorax. A total of 17 (89%) of our patients survived uneventfully and 2 died due to complications unrelated to the cysts.

Castleman disease (CD), first described by Benjamin Castleman as angiofollicular mediastinal lymph–node hyperplasia, is a rare benign lymphoproliferative disorder with varied modes of presentation. Its common presentation within the mediastinum misleads the clinician and merits special attention since it is essentially a diagnosis of exclusion. We are sharing our experience with three patients, within a relatively short period of 2 years. All three presented with a mediastinal mass, however, each of them came with an entirely different clinical scenario and diagnosis. All three were successfully operated and Castleman disease [hyaline–vascular (HV) type] was diagnosed only after the final histopathology.

We report the case of a 52-year-old patient with type 2 diabetes mellitus diagnosed with adenocarcinoma rectum, presenting with the complaint of breathlessness to the emergency department. Chest radiograph done showed a left-sided hydropneumothorax with mediastinal shift to the right side. Tube thoracostomy was done. Pleural fluid was exudative; there was no evidence of malignancy. The patient developed a right-sided pleural effusion; anaerobic bacteria were grown on pleural fluid culture. Computed tomography (CT) of the chest was done in view of the new onset empyema on the right side. The CT showed pneumomediastinum and periesophageal air pockets. Orally administered methylene blue had appeared in the pleural drain confirming the diagnosis. The patient was taken up for feeding jejunostomy and repair of tear was planned for a later date. He succumbed to sepsis due to empyema.

This is a case of a 68-year-old man who came with complaints of chronic dry refractory cough of 3-month duration. He is a known case of atrial septal defect (ASD). Chest radiograph done showed prominent convex pulmonary bay with right hilar mass. Contrast-enhanced computed tomography (CECT) thorax was done. The mass-like lesion was found to be an enlarged and dilated pulmonary artery. The refractory cough was due to compression of larger airways by pulmonary trunk.

Understanding the etiology and the tempo of progression with inexorable and self-perpetuating fibrosis [identification of progressive-fibrotic (PF) phenotype of interstitial lung disease (ILD) (PF-ILD)] can help to decide the treatment of diffuse parenchymal lung disease (DPLD) in the real-world practice. An evidence-supported pragmatic approach has been forwarded for such circumstances.