The whole world has witnessed an unimaginable, unforgettable medical disaster in the last 1 and ½ years in form of the demise of innumerable people due to the current pandemic of SARS COV-2. Despite several efforts to develop strong evidence-based effective and safe treatment regimens, the options remain very limited, to date. Vasoactive intestinal peptide (VIP) discovered as a gut peptide hormone in earlier days was found to have diversified physiological action with specific features of lung protection-related activities. It has a unique feature of binding to angiotensin-converting enzyme (ACE) receptor of Type II alveolar cell to which the COVID 19 virus also binds. Aviptadil as a synthetic VIP has already been proved to be an effective option in the treatment of severe respiratory failure due to sepsis and other related lung injuries. Interim analysis results of this drug use in respiratory failures caused by SARS COV-2 has evolved a new hope in regards to safety and efficacy. Final results from recently completed as well as currently, ongoing trials will clarify the class effect of this drug in the treatment of COVID 19 in the days to come.

Pulmonary tuberculosis (TB) is a leading cause of mortality and morbidity worldwide. In recent years, patients with chronic respiratory diseases have been found to have a decreased quality of life. Pulmonary TB is also a significant risk factor for chronic respiratory diseases due to its effect on lung function. Although patients with pulmonary TB are considered “successfully treated” and “cured” by completing the full treatment, patients often struggle with post-TB sequelae to the lung leading to impaired functional status and decreased Quality of life. Pulmonary rehabilitation is an effective tool to improve the clinical, physical, psychosocial, and overall quality of life. This review highlights the role of pulmonary rehabilitation in patients with pulmonary TB sequelae.

Context: Reduced basal metabolic rates (BMRs) are said to be common in obese or sedentary adults. Very few investigations have analyzed the BMR relationship with that of respiratory functions in middle-aged obese individuals. Objectives: We aimed to determine the sex differences in BMR and spirometric measures in obesity and evaluate the association of BMR with respiratory functions in middle-aged people. Methods: This analytical study was undertaken in healthy normal-weight and obese men and women (50 each) of age 35-55 years. Body mass index (BMI), percentage of body fat, fat mass, and fat-free mass were estimated and BMR was calculated using predicted equations. Spirometric measures such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), FEV₁/FVC, peak expiratory flow rate, mean forced expiratory flow during the middle of FVC (FEF_25%-75%), and maximum voluntary ventilation were assessed in both sexes. Independent two-sample t-test and Pearson's correlation were used as tests of significance with P ≤ 0.05 affirming the statistical significance. Results: BMR among men showed significantly higher mean scores than females. In obese group, most of the respiratory function parameters except FEV1/FVC ratio were significantly reduced in females compared to men. An inverse correlation existed between BMR and FEV1/FVC ratio, whereas BMR observed a positive correlation with all other respiratory function measures among both obese and nonobese. Conclusions: To study the early lung function alterations in the obese, it is necessary to take into account the sex differences, BMR, and body composition instead of BMI alone.

Introduction: Dyspnea or shortness of breath is one of the cardinal features of chronic respiratory diseases (CRDs). It is a subjective symptom, frequently influenced by the state of mind of the patient. Kinesiophobia, excessive, irrational fear of physical movement due to dyspnea, often prevents patients from performing activities of daily living leading to physical deconditioning. The identification of relationship of dyspnea-related kinesiophobia and activity limitation can help guide patient management to improve quality of life, physical independence, and prevent physical deconditioning. Patients and Methods: The study was conducted using convenience sampling at a tertiary care hospital on 18-60-year-old patients with CRDs with dyspnea. Breathlessness Belief Questionnaire (BBQ) was used to evaluate dyspnea-related kinesiophobia. Activity limitation was assessed using Dyspnea Barthel Index (DBI). The scores of both scales were calculated, and the correlation between dyspnea related kinesiophobia and activity limitations was obtained using the Spearman's correlation. Results: Sixty subjects, 23 females and 37 males, were recruited. The mean (± standard deviation [SD]) age of the patients was 48.9 ± 12.5 years. Mean ± SD scores of BBQ were 58.4 ± 4.5. The mean score for DBI was 21.5 ± 2.12, and the average duration of the disease was 2 ± 0.707 years. Spearman's rank correlation coefficient between BBQ and DBI obtained was p = 0.712 with a P < 0.001. Conclusion: There is a strong correlation between dyspnea-related kinesiophobia and activity limitation in patients with CRDs.

Objective: The present study was conducted to translate the original English version of Modified Borg Scale (CR-10) in Hindi language and validate Hindi translated version of the scale for its use in healthy Indian adult population. Subjects and Methods: An observational analytical study was conducted on 50 healthy Indian subjects (24 males, 26 females) who were recruited from a tertiary healthcare setup. The study was conducted in two parts: 1^st part included translation of English version of Modified Borg Scale (CR-10) in Hindi language by cross-cultural adaptation process. 2^nd part included validation of Hindi translated version of Borg CR-10 scale by correlating subjective values of rating of perceived exertion (RPE) with the objective parameters of heart rate (HR) and maximal oxygen consumption (VO₂ max) during a Bruce treadmill protocol. Results: Spearman correlation coefficient was computed between subjective and objective measures. The results of the study showed that there was a high positive correlation between RPE and HR with r = 0.822, P < 0.01 and r = 0.97, P < 0.05 by using two different methods of statistical analysis. There was a moderate correlation between RPE and VO₂ max with r = 0.587, P < 0.01 by using method 1 and a high correlation with r = 0.98, P < 0.05 by using method 2. Conclusion: The Hindi version of Borg CR-10 Scale is a valid tool to measure perceived exertion during Bruce protocol on a motorized treadmill in a healthy Indian adult population.

Introduction: The concept of learning styles has many implications for students and educators. Implementing a variety of teaching strategies by identifying and applying the student learning styles would enhance teaching effectiveness by increasing the information retention and depth of comprehension. Aim: To determine the learning style of respiratory therapy (RT) students using Arabic translated Kolb's learning style questionnaire. Methodology: This was a cross-sectional, prospective study among RT students in a private medical college in Saudi Arabia. Kolb's Learning Style Inventory (LSI) Questionnaire was translated to Arabic and validated. Questionnaire was sent in the Google form and the spreadsheet was created from the responses. The LSI questionnaire was sent to the students through the official E-mail ID requesting them to participate in this survey. Student's learning style was calculated according to Kolb's LSI manual. Descriptive statistics are reported as frequency and percentages. SPSS 16.0 (SPSS Inc, Chicago, Illinois, USA) was used. Results: A total of 84 participants (25 males, 59 females) responded out of the 150 survey questionnaires that was sent (response rate: 56%). Most students had the Active Experimentation (AE) pattern of learning. The dominant learning style was convergent among the respondents. Both male and female participants had AE as the prominent learning style. Conclusion: Arabic translation of Kolb's Learning style questionnaire is found to be valid instrument for the assessment of RT students. The convergent style is the dominant learning style among RT students.

Introduction: Two-minute walk test (2MWT) is used widely to determine the functional capacity in clinical setup. However, reference equations derived from Western population cannot be applied to Indian subjects owing to the ethnic differences. Hence, the current study aimed to establish reference equation for 2MWT in healthy Indian population. Subjects and Methods: A cross-sectional study was conducted in 480 healthy participants in the age group of 20-80 years who performed two 2MWTs using a standardized protocol. The highest value of two-minute walk distance (2MWD) was selected for further analysis. Results: The mean value of 2MWD was 152.33 ± 26.56 m. 2MWD for men (157.3 ± 23.82 m) was higher than females (147.35 ± 28.21 m) (P < 0.001). Bivariate analysis showed that 2MWD correlated significantly (P < 0.05) with age, height, and weight in both genders. Further, stepwise multiple linear regression analysis was performed to generate gender-specific reference equations using age, height, and weight as predictors of 2MWD. Conclusion: We established a gender-specific prediction equation for 2MWD in healthy Indian subjects. It can be used as a reference to interpret functional capacity in patients with acute illness, cardiorespiratory disease, and other health-related conditions.

Introduction: Tuberculosis (TB) is an airborne disease caused by Mycobacterium tuberculosis that usually affects the lungs, leading to fever, cough, and chest pain. Although a declining trend was observed in most developed countries, TB remains a leading cause of morbidity and mortality in many developing countries, including India. Materials and Methods: This prospective study was carried out using 150 sputum samples of suspected pulmonary TB patients. All the samples were subjected to ZiehlÂ-Neelsen stain, cartridge-based nucleic acid amplification test (CBNAAT) and culture on LowensteinÂ-Jensen (LJ) media. They were compared for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in terms of quantitative results. Results: CBNAAT results of the sputum samples showed a sensitivity of 100%, 88.7% specificity, 90.3% PPV, and NPV 94%, whereas culture on LJ media showed a sensitivity, specificity, PPV, and NPV of 68.3%, 100%, 100%, and 73.9%, respectively. Conclusion: Whereas culture remains the gold standard for the diagnosis of TB, CBNAAT has taken over the domain of diagnosis owing to its high sensitivity and rapid turn over time.

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is an immunologic pulmonary disorder caused by a complex hypersensitivity response to inhaled fungal antigens. ABPA occurs most commonly in immunocompetent patients and complicates 1% to 2% of cases of persistent asthma and 7% to 14% of cases of chronic steroid-dependent asthma. Aim: The aim of this study was to study the clinical and radiological profile of patients and to study the serological correlation of ABPA. Methodology: This was a retrospective study done over 6 months from June 2020 to December 2020. Patients who were confirmed cases of ABPA according to the International Society for Human and Animal Mycology criteria were enrolled for the study. Patients demographic data, pathological, and radiological test results were collected and analyzed. Pre- and post-bronchodilator spirometry of the patients were examined and asthma control was calculated. Results: In the present study, 23 patients were studied. Most patients were young, the mean age was 35.7 years with a female predominance of 56.5%. The most common symptom was cough in 91.3% of patients. All patients had bronchial asthma as a predisposing factor. The mean absolute eosinophil count and mean serum immunoglobulin E were 534 cells/μL and 2270 UI/ml, respectively. About 82.6% of participants in the study had spirometry suggestive of obstructive pattern. Bronchiectasis and parenchymal opacities were the most common radiological abnormality seen. Conclusion: The diagnosis of ABPA must be considered when treating difficult to control asthma. A delay in diagnosis can lead to decreased asthma control, worsening of lung function, sometimes leading to irreversible changes, poor quality of life, and increased cost of treatment.

Introduction: Management of complicated parapneumonic effusions (CPEs) and empyema is difficult, as no clear guidelines exist. The use of intrapleural fi brinolytics has shown promising results in several studies. Objective: The objective was to study the safety and efficacy of streptokinase (STK) in multiloculated empyema in children. Patients and Methods: This is a comparative descriptive study which included initial 50 patients in the STK group and subsequent 50 patients in the placebo group. Intrapleural STK was given twice daily at a dose of 5000 IU/kg for 7 days. In the placebo group, 50-ml normal saline was instilled intrapleurally through the chest tube. The patients were assessed for safety and efficacy of STK. The efficacy of STK was assessed by expansion of lung on chest-X-ray and breakage of loculi on thoracic ultrasound. Success of STK therapy was assessed by decrease in number of surgical referrals for decortication. Results: The amount of intercostal tube drainage output as well as mean duration of its insertion was statistically significant in the STK group. The percentage of overall success was 84% of patients in the STK group versus 52% in the placebo group, and the difference was statistically significant. Decortication was required in 24% of patients in the STK group and 60% of patients in the placebo group, which was again statistically significant. Conclusion: Instillation of STK in multiloculated empyema is safe and effective and decreases referrals for surgery. Awareness needs to be created among health-care workers for prompt diagnosis and treatment of patients of CPE and empyema with intrapleural fibrinolytics before surgical referral.

Background: Atypical category of COVID-19 could not be differentiated from tuberculosis (TB) in high-resolution computed tomography (HRCT) of the chest because of similar imaging features. This study aims to distinguish between the HRCT features of TB and atypical COVID-19. Methodology: Interferon-gamma release assay (IGRA) was performed in all the 54 COVID-positive patients, showing atypical COVID features that are suspicious of TB on the HRCT chest. Atypical imaging features such as a tree in bud nodules, patchy consolidations, cavitation with surrounding consolidation, discrete nodules, mediastinal lymphadenopathy, and pleural effusion were analyzed in 50 IGRA-negative patients. Results: We found trees in bud nodules (93%) and consolidations (56%) involving predominantly lower lobes, i.e., superior and posterobasal segments. Discrete nodules and cavitation with surrounding consolidation were seen involving predominantly upper lobes (78 and 57% cases, respectively), i.e., apicoposterior and lingular segments of the left upper lobe. The maximum number (67%) of right paratracheal enlarged nodes and bilateral pleural effusions (71%) were found in IGRA-negative COVID-19 patients. Conclusions: It is not always possible to differentiate features of atypical COVID-19 from TB based on HRCT chest alone because of similar appearances and distribution of tree in bud nodules, consolidation, cavitation, and lymphadenopathy in HRCT chest. Since both bilateral and unilateral pleural effusions may be seen in TB, it is impossible to differentiate COVID-19 from TB based on pleural effusion. Therefore, exclusion of TB will need supportive, relevant laboratory investigations (Sputum acid fast bacilli, cartridge-based nucleic acid amplification test, and IGRA) for appropriate diagnosis and management.

This article aims to present the spectrum of pulmonary fungal infections observed in postcoronavirus disease 2019 (COVID-19) diabetic patients. In this case series, three post-COVID-19 diabetic patients with poor glycemic control were diagnosed with pulmonary mucormycosis, invasive candidiasis, and pulmonary aspergillosis, respectively. The patients were subjected to clinical, radiological evaluation, including bronchoscopy. The etiologic agents were isolated in these cases and identified by biopsy and subsequent histopathological confirmation. A high index of suspicion, early use of appropriate diagnostic methods aided with suitable antifungal agents, and control of risk factors such as diabetes mellitus are the main factors governing the successful management of fungal infections in post-COVID-19 immune-suppressed patients, presenting with worsening respiratory symptoms.

Urinothorax is a rare condition which is defined as collection of urine in the pleural space due to retroperitoneal leakage of urine into the pleural space. It is a rare cause of transudative pleural effusion. It is usually obstructive or traumatic in etiology. It is a rare complication associated with percutaneous nephrolithotomy (PCNL). We report the case of a 29-year-old female who presented with massive pleural effusion that developed in the patient who had undergone PCNL for renal stones. Thoracocentesis was done, and creatinine levels in pleural fluids were measured for diagnosis of urinothorax. For diagnosis, awareness of condition and high degree of clinical suspicion is required. Imaging modality such as computed tomography of the abdomen is useful for allocation of anatomical defect causing retroperitoneal leakage of urine or urinoma. We highlight the importance of early diagnosis of urinothorax for prompt treatment of the underlying condition.

Barotrauma has many different presentations, including pneumothorax, subcutaneous emphysema, pneumoperitoneum, and pneumomediastinum. We have presented and analyzed some interesting cases of barotrauma in this case series. Case 1 in our series developed a thin-walled new cavity due to barotrauma, mimicking pneumatocele and fungal cavity. Case 2 presented with coexistence of pneumothorax and cavity with fungal infestation. Severity of barotrauma due to positive pressure ventilation has been shown in case 3. An interesting case of barotrauma in a 36-week primigravida, post cesarean section, causing dehiscence of scar, presented as case 4 in our series. Early and rapid imaging diagnosis of barotrauma should be pursued. In patients with mechanical ventilation, identifying small changes in imaging characteristics of cavitary lesions, such as fungal, bacterial, or transient cavities, would aid physicians in offering a correct treatment plan.

Lung carcinoma may erode into different adjacent structures and cause various local complications, including the formation of fistulas. A middle-aged male with a history of fever, cough with hemoptysis, and progressive dyspnea was found to have right upper lobe non-small cell carcinoma of the lung. Subsequently, he developed right pyopneumothorax and persistent air leak suggestive of bronchopleural fistula and suffered hypoxic cardiac arrest. Postintubation and return of spontaneous circulation, the patient started exhibiting persisted air leak from oral cavity, which made ventilation difficult along with leak via chest drain. An ulcer around the upper esophagus necessitated a computed tomography scan, which revealed two trachea-esophageal fistulas. Left-sided one-lung ventilation was employed, which improved ventilation, but the patient succumbed to the underlying disease process and septic shock. On the background of lung carcinoma and a known leaking process, a source of a second leak can often be missed. Positive pressure ventilation can be a daunting task in the presence of two concomitant leaking processes. Thus, it is imperative for an intensivist to have a high index of suspicion to detect such occurrence in a patient with lung carcinoma.

Pulmonary hamartomas are rare, benign lung tumors. They are usually asymptomatic, and are present as solitary or multiple, round nodules. Here, we report an unusual presentation of pulmonary hamartoma in a 60-year-old male, mimicking pulmonary tuberculoma. Histopathological examination subsequent to wedge resection confirmed the diagnosis of pulmonary hamartoma.

Perioperative management of anterior mediastinal mass may be difficult to manage for anesthesiologists as well as thoracic surgeons. General anesthesia is preferred approach for such surgeries, but there is the risk of compression of the trachea after induction. A more physiological and less invasive method is thoracic epidural anesthesia without endotracheal intubation. An anterior mediastinal mass was excised successfully in the fully awake patient under high thoracic epidural block in a tertiary care institute. This approach may be replicated further in the management of patients with compromised pulmonary reserve with a reduction of length of stay in intensive care unit and hospital.

Spontaneous pneumothorax is a very uncommon occurrence in patients having coronavirus disease 2019 (COVID-19) pneumonia. It is mostly seen due to barotrauma in patients receiving mechanical ventilation. Although it may occur at different courses of COVID pneumonia and in patients with no underlying lung disease, it has been seen in patients having underlying asthma, chronic obstructive pulmonary disease, and bronchiectasis. This report describes spontaneous pneumothorax in a silicosis patient during the course of COVID-19 pneumonia with successful outcomes. Possible mechanism of pneumothorax in COVID-19 pneumonia and contributing the role of silicosis is also mentioned with the importance of detecting such complications in time to reduce mortality in such patients.