Indian Journal of Respiratory Care

Cavitating pulmonary tuberculosis (PTB) frequently occurs in adults and is uncommon in children. We report a case of a 3-year-old female child who presented with complaints of fever, cough, and poor weight gain. Clinical findings and chest X-ray were suggestive of right lower lobe pneumonia. The patient was treated with IV antibiotics, responded well, and was discharged. She presented with a recurrence of fever and weight loss. High-resolution computerized tomography of the thorax revealed cavitation in the posterior-basal segment of the right lower lobe of the lung. She was treated with antitubercular therapy (ATT) and responded well to the treatment. How to cite this article Kini P, Laxminarayana M, Bhunia S. Cavitating Pulmonary Tuberculosis in a 3-year-old Child: A Case Report. Indian J Respir Care 2024;13(4):253–255.

Background Chronic obstructive pulmonary disease (COPD) is considered to be a systemic inflammatory state. There is an increase in the circulating markers of inflammation like interleukin-6 (IL-6), tumor necrosis factor-alpha, and C-reactive protein (CRP) in COPD patients, which are reported to be associated with disease severity. IL-6 levels are found to be increased in overweight/obesity as well. However, increased body mass index (BMI) has been documented to show a protective effect on COPD. The current study was planned to explore the association of IL-6 with BMI and grades of disease severity. Materials and methods The study design was observational and cross-sectional and included 70 diagnosed cases of COPD. The patients were divided into underweight, normal weight, and overweight/obese groups by Asian criteria based on BMI. The circulating IL-6 and CRP levels were measured. The disease severity was assessed by the Global Initiative for COPD criteria. Results No significant difference was found in IL-6 and CRP levels among different subgroups based on BMI (p > 0.05). However, a statistically significant difference was found in IL-6 and CRP levels among patients with mild, moderate, and severe disease (p < 0.001). A significant correlation was found between IL-6 and CRP, but no significant correlation was found between these and BMI. Conclusion The present study does not support the obesity paradox in COPD, as no significant association of BMI with disease severity was found, whereas IL-6 and CRP showed a significant difference among patients with different severity grades. How to cite this article Gupta S, Saini V, Jaswal S, et al. Association of Interleukin-6 Levels with Body Mass Index in Chronic Obstructive Pulmonary Disease Patients. Indian J Respir Care 2024;13(4):221–225.

How to cite this article: Choudhary P. Is Closed Suction System Better than Open Suction System to Minimize the Risk of Infection? Indian J Respir Care 2024;13(4):219–220.

Introduction Blastocystis hominis is a single-celled organism that is usually found in the intestinal tract. Clinical manifestations of B. hominis infection in humans are nonspecific and include diarrhea, abdominal pain, cramps or discomfort, and nausea. Case description A 47-year-old male came with a chief complaint of worsened shortness of breath for 2 weeks before being admitted to the hospital. Chest ultrasound showed a large right pleural effusion. We performed thoracocentesis and inserted a chest tube to drain the pus. Lugol staining of the pleural fluid showed the presence of B. hominis. The patient was treated with metronidazole and trimethoprim/sulfamethoxazole (TMP/SMX). Discussion B. hominis has an equivocal role among intestinal parasites due to a lack of knowledge regarding its biology and evidence of its pathogenicity. Based on this case, the treatment that we provided produced a good response for the patient, and B. hominis as the cause of the disease can be considered. Conclusion Despite it being thought to only infect the intestinal tract, in this case, we found that B. hominis can also be the cause of thoracic empyema. Treatment with metronidazole and TMP/SMX in the patient resulted in the resolution of the disease. How to cite this article Imaniar R, Sari IP, Handayani D, et al. An Unusual Case of Thoracic Empyema Due to Blastocystis hominis. Indian J Respir Care 2024;13(4):256–258.

How to cite this article: Ramalingam G, Saminathan G. Addressing Emerging Antibiotic Resistance Patterns: Implications for Public Health and Treatment Strategies. Indian J Respir Care 2024;13(4):270–270.

Aim and background This study aimed to evaluate smartphone game application with the Buteyko breathing technique to improve pulmonary function in asthma patients. Airway constriction and inflammation are the hallmarks of asthma. It is the most prevalent chronic illness in both adults and children. Although there are many recent studies showing the effectiveness of various methods, the Buteyko method and game therapy applications may reduce medication needs and symptoms. Methods This was a quasi-experimental study of pre- and posttrial type carried out with 30 children diagnosed with asthma. Based on the inclusion and exclusion criteria, they were chosen using a simple random sampling method and split into two groups. Subjects of group A received the Buteyko breathing technique, and subjects of group B received the Buteyko breathing technique along with an interventional digital breathing technique, for 15 minutes, 5 sessions per week for 4 weeks. The pre- and posttest were analyzed using the Asthma Control Test and the Becker Asthma Score. Results On comparison, a significant difference in means at p ≤ 0.05 was observed in group B when comparing the Academic Competence Test (ACT) and Behavioral Assessment Scale (BAS) scores of groups A and B between pre- and posttests. Conclusion The Buteyko breathing technique along with the Digital Interventional Breathing Technique is more effective in improving pulmonary function in asthma patients compared to the Buteyko breathing technique. The findings of this study pave the way for depicting the role of games in the treatment protocol, by improving the interaction of the patient and thereby improving pulmonary function. Clinical significance The evaluation of digital solutions for asthma, including artificial intelligence (AI)-assisted breathing techniques and the Buteyko method, holds significant clinical relevance. These innovative approaches offer potential advancements in personalized asthma management by improving breathing efficiency and reducing reliance on medication. Digital interventional breathing techniques can provide real-time feedback and tailored exercises, while the Buteyko method emphasizes controlled breathing to reduce symptoms. Together, these technologies promise to enhance patient outcomes, increase adherence to treatment protocols, and ultimately improve the quality of life for individuals with asthma. How to cite this article Rachel CJ, Raman K, Blessy T, et al. Redefining Respiratory Care with Digital Interventions in Children with Bronchial Asthma: Exploring the Efficacy of Game-based Breathing Training and the Buteyko Method. Indian J Respir Care 2024;13(4):243–247.

How to cite this article: Takbhate R, Patil-Takbhate B, Tripathy S, et al. Undiagnosed Sleep Apnea: Exacerbating the Postcoronavirus Disease Symptoms? Indian J Respir Care 2024;13(4):271–272.

Aim and background To analyze the demographic, clinical, and outcome characteristics of patients with acute respiratory failure (ARF) and to assess the impact of various factors on patient outcomes. Materials and methods A total of 275 patients with ARF were included in this study. The mean age of patients was 48.18 ± 16.34 years, with a male predominance (64.0%). The distribution of respiratory failure types was as follows: 78.5% had type 1, 18.5% had both type 1 and type 2, and 2.9% had type 2 respiratory failure. Patients received different types of respiratory support: 50.5% with oxygen therapy (face mask, nasal cannula, etc.), 24.4% with noninvasive ventilation (NIV), and 25.1% required mechanical ventilation. Results The most common etiology was pneumonia (18.5%), followed by heart failure (18.2%), poisoning (17.1%), sepsis (16.4%), and acute exacerbation of chronic obstructive pulmonary disease (COPD) (7.3%). Additional etiologies included acute pancreatitis, fluid overload, diabetic ketoacidosis, malignancies, and other less common conditions. The predominant symptom at presentation was breathlessness (58.2%), with fever (33.1%), cough (23.6%), and vomiting (23.3%) also frequently observed. The mortality rate was 77.1%, with 22.9% of patients being discharged. Significant associations were found between mortality and poisoning (χ² = 13.862, p < 0.001), altered sensorium (χ² = 4.054, p = 0.044), and vomiting (χ² = 5.117, p = 0.024). Fever was associated with a higher likelihood of discharge (χ² = 4.758, p = 0.029). There was no significant difference in outcomes based on the type of respiratory failure (χ² = 1.144, p = 0.564). However, the type of respiratory support significantly impacted outcomes, with mechanical ventilation being associated with higher mortality (χ² = 15.873, p < 0.001). Conclusion Pneumonia was the most common cause of ARF, and breathlessness was the most common symptom. Mortality was high, with significant associations between certain presenting symptoms and outcomes. Respiratory support type significantly influenced patient outcomes, highlighting the critical role of tailored respiratory management in improving survival. Clinical significance Early identification and tailored management of ARF, including careful selection of respiratory support and attention to high-risk symptoms, are crucial for improving outcomes. How to cite this article Deme S, Durgam R, Kakarla B. Analyzing Factors Influencing Mortality in Acute Respiratory Failure: A Comprehensive Study of 275 Patients. Indian J Respir Care 2024;13(4):233–237.

Aim To determine the prevalence of dysfunctional breathing (DB) in subjects undergoing maintenance dialysis. Background DB involves abnormal breathing patterns either without organic disease or secondary to cardiopulmonary/neurological conditions like asthma or heart failure. Indicators include asynchronous thoracic and abdominal movements, upper thoracic breathing, frequent sighs, mouth breathing, and excessive use of accessory respiratory muscles. DB can be assessed using the Nijmegen Questionnaire (NQ) and the Self-evaluation of Breathing Questionnaire (SEBQ). The NQ, with a sensitivity of 91% and specificity of 95%, considers a score above 23 indicative of DB. The SEBQ, with an intraclass correlation coefficient of 0.89, uses a cutoff score of 11 for DB. Additionally, the Manual Assessment of Respiratory Motion (MARM) helps assess DB through physical examination. Materials and methods The study enrolled 69 participants aged 18–60 who had undergone more than three dialysis cycles. Exclusions included chronic respiratory disease, recent abdominal surgeries, and smoking. Participants completed the NQ and SEBQ, followed by an MARM physical assessment. Results The average age of participants was 41.8 ± 10.9 years. Of the 69 subjects, 21 scored above 23 on the NQ, indicating DB in 30.43% of the sample. On the SEBQ, 66 subjects scored above 11, indicating DB in 95.65%. MARM helped identify abnormal breathing patterns and asymmetry. Conclusion Using the NQ and SEBQ, the prevalence of DB in subjects undergoing dialysis was found to be 30.43 and 95.65%, respectively. How to cite this article Bora ND, Mishra AS, Ganachari PS, et al. Prevalence of Dysfunctional Breathing in Subjects Undergoing Maintenance Dialysis: A Cross-sectional Study. Indian J Respir Care 2024;13(4):238–242.

Tuberculosis (TB) continues to be regarded as one of the leading diseases of infectious origin, accounting for the maximum number of deaths. Even though, owing to consistent and concerted efforts, we have made progress in terms of saving the lives of affected individuals and ensuring access to treatment, we are still off track in meeting our targets to end the disease epidemic by the year 2030. To interrupt the present trajectory of TB, there is an immense need to ensure access to disease-related prevention and care services, promote research and development, and introduce innovations. In the proposed initiative, five specific strategies—namely Engage, Accelerate, Align, Account, and Advocacy—have been proposed. In conclusion, in the battle against one of the deadliest infectious diseases, it is extremely crucial that no one must be left behind in equitably accessing prevention and care-related services. The proposed initiative is an attempt to intensify the ongoing efforts and thereby ensure that we take appropriate measures to be on the right track to attain the set targets by 2030. How to cite this article Shrivastava SR, Bobhate PS. Promoting Universal Access to Tuberculosis through a Five-pronged Strategy: World Health Organization. Indian J Respir Care 2024;13(4):268–269.

Managing drug-resistant tuberculosis (MDR-TB) in patients with underlying coagulation disorders such as hemophilia and combined factor V and VIII deficiency presents significant challenges due to the risk of bleeding and potential drug-related complications. This case series details two unique instances of MDR-TB in such patients, exploring the complexities of treatment. Tuberculosis, known to induce a hypercoagulable state, can further complicate existing coagulation abnormalities. Using individualized shorter all-oral MDR-TB regimens alongside careful monitoring, both patients were successfully treated without severe bleeding episodes or deterioration in their coagulation profiles. This series highlights the importance of therapeutic approaches with close interdisciplinary collaboration to manage such cases effectively and improve patient outcomes. How to cite this article S RR. Challenges and Triumphs: A Case Series of Drug-resistant Tuberculosis Management in Patients with Coagulation Disorders. Indian J Respir Care 2024;13(4):265–267.

Addison's disease (AD) was first described in 1855 by Thomas Addison, a physician and medical researcher. Previously, tuberculosis (TB) was a frequent cause of AD. There has been a decrease in adrenal TB as a result of antimicrobial chemotherapy. Adrenal TB involves bilateral glands more frequently due to hematogenous spread. Due to the obscure symptoms, it is often onerous to diagnose acute adrenal insufficiency. Patients usually present with severely reduced blood pressure, shock, acute onset abdominal pain, fever, and even vomiting. Chronic insufficiency presents with complaints of fatigue, decreased muscle strength, and irritability. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) are useful in differentiating tubercular AD from other potential causes of adrenal insufficiency. Treatment involves antitubercular treatment (ATT) as well as maintenance steroids, as rifampicin, which is a part of ATT, is a potent cytochrome P450 enzyme inducer, lowering the adrenal reserve. A 37-year-old male presented to the hospital with complaints of cough and intermittent fever with evening rise in temperature for 6 months. He had tachycardia, hypotension, high-grade fever, along with unintentional weight loss and fatigue. Investigations reduced serum cortisol, sputum showed the presence of acid-fast bacilli. The patient was initiated on oral steroids and antitubercular therapy. The patient's overall symptoms improved and he was discharged with the same. How to cite this article N K, Jyothi, Chikkeri SS. Tuberculous Addison's Disease: A Forgotten Cause—A Case Report. Indian J Respir Care 2024;13(4):259–264.

Aim and background Chronic obstructive pulmonary disease (COPD) is one of the primary factors contributing to death globally each year. Reactive oxygen species (ROS) are recognized to aid in the development of this disease, but which ROS contributes the most is not clearly understood yet. This research sought to look into which ROS contributes the most to the progression of COPD. Materials andmethods: To achieve this aim, we assessed the quantities of the three major ROS contributing to human diseases, which are superoxide anion radical (O₂•⁻), hydroxyl radical (•OH), and singlet oxygen (¹O₂) in COPD patients as well as healthy individuals by electron spin resonance (ESR) spectroscopy. We also measured the quantities of markers of biomolecule (lipid, protein, DNA) oxidation, that is, malondialdehyde, protein carbonyl groups, and 8-hydroxy-2-deoxyguanosine, in COPD patients and healthy controls using respective ELISA kits. Results The level of O₂•⁻ in control samples was 3460 ± 170 r.u., while in patient samples it was 7842 ± 166 r.u. The •OH level was found to be 8460 ± 850 r.u. and 16560 ± 1425 r.u. in the control and patient samples, respectively. The ¹O₂ level in controls was 2728 ± 263 r.u., and in patients, it was 3728 ± 249 r.u. The level of MDA was 203.20 ± 9.73 pg/mL and 434.00 ± 39.11 pg/mL in controls and patients, respectively. The levels of protein carbonyl group formation and 8-OHdG were 6.98 ± 0.84 mmol/mL and 15.84 ± 2.06 ng/mL in controls, while 16.67 ± 1.44 mmol/mL and 33.66 ± 1.92 ng/mL in patients, respectively. Conclusion The outcomes of our research point out that hydroxyl radical is the major ROS formed in COPD patients, contributing to the progression of the disease by mainly oxidizing DNA. How to cite this article Pathak V, Kumar N, Nirala P. Role of Hydroxyl Radical in the Progression of Chronic Obstructive Pulmonary Disease. Indian J Respir Care 2024;13(4):226–232.

Introduction Obstructive sleep apnea (OSA) is characterized by recurrent airway obstructions, resulting in decreased oxygen levels and disrupted sleep. These episodes can manifest as hypopnea or apnea, affecting respiratory muscle function, lung capacity, and chest compliance. OSA significantly impacts exercise tolerance and aerobic capacity, with severity influencing these limitations. Aim This study aims to evaluate lung function, respiratory muscle strength (RMS), and functional exercise capacity (FEC) and to investigate how various factors affect respiratory parameters and FEC in individuals with OSA. Methods The study included 30 patients aged 18–80 years, of both genders, diagnosed with OSA and chronic obstructive pulmonary disease. Those with significant cardiopulmonary, neuromuscular, or orthopedic disorders affecting functional capacity were excluded. Lung function was measured using a Medical International Research (MIR) Spirometer for forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the FEV1/FVC ratio, while RMS was assessed with a manovacuometer for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). FEC was determined using the six-minute walk test. Results The mean values for FVC, FEV1, and the FEV1/FVC ratio were 1.44 (0.51), 1.29 (0.42), and 92.87 (7.08), respectively. The mean distance covered in the six-minute walk test was 92.35 (52.53). There was a positive correlation in RMS and a positive relationship between lung function and FEC in patients with OSA. Conclusion The findings indicate a decline in lung function, RMS, and functional capacity in OSA patients. How to cite this article Mohan P, Sridevi S, Senthil kumar TG. A Study to Analyze Lung Function, Respiratory Muscle Strength, and Functional Exercise Capacity in Obstructive Sleep Apnea Patients. Indian J Respir Care 2024;13(4):248–252.

Aim and background Inhaled corticosteroids (ICS) and bronchodilators remain the mainstay of therapeutic modalities available for the management of chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effectiveness, utility, and economic analysis of a three-drug treatment vs a two-drug treatment in COPD patients. Materials and methods An observation was conducted at a superspecialty hospital in Hyderabad. Out of the 115 patients recruited from the inpatient and outpatient wards of the Pulmonology Department, 55 patients received triple therapy containing ICS, long-acting β-agonists (LABA), and long-acting muscarinic antagonists (LAMA), whereas 60 patients were treated with dual therapy comprising ICS/LABA. Cost-effectiveness was assessed based on forced expiratory volume in 1 second (FEV1) (FEV1% predicted), St George's respiratory questionnaire (SGRQ) scores, SGRQ responder ratio, COPD assessment test (CAT) scores, and incremental cost-effectiveness ratio (ICER). Results Results signified the enhanced potency of three-drug treatment vs two-drug treatment as proven by the improvement in average difference from initial values in (1) FEV1% predicted value of 4.36 [95% confidence interval (CI) (2.9–5.82)], (2) SGRQ scores of −6.76 [95% CI (−2.14 to −11.38)], SGRQ responder ratio of 13.25 (3.72–47.24), CAT scores of −5.15 [95% CI (−9.87 to −0.43)] and ICER of 3522 [95% CI (14682 to −7638)]. Conclusion Triple therapy comprising LABA, LAMA, and ICS can optimize lung function and improve clinical outcomes, leading to overall enhancement of well-being compared to LABA/ICS dual therapy in moderate to severe COPD patients. Clinical significance Three-drug treatment comprising ICS/LABA/LAMA is an effective and cost-effective therapeutic approach for managing moderate and severe COPD compared to ICS/LABA dual therapy. This is evidenced by improvements in spirometry values (FEV1% predicted) and health-related quality of life (HRQoL). How to cite this article Syed AA, Panda S, NM A. Effectiveness, Utility, and Economic Analysis of Three-drug Treatment vs Two-drug Treatment in Chronic Obstructive Pulmonary Disease Patients. Indian J Respir Care 2024;13(3):146–151.

Background and objectives Obstructive sleep apnea (OSA) is being progressively encountered in clinical practice due to the mounting epidemic of obesity, owing to an upsurge in sedentary habits in rural and urban populations. Sleep-related disorders are a common cause of morbidity and can lead to wide range of potentially fatal health problems such as high blood pressure, obesity, hypercholesterolemia, diabetes, heart attacks, and depression. The current study was steered with the objective to estimate the prevalence of comorbidities in patients with OSA and to evaluate the association between comorbidities and severity of OSA. Materials and methods Sixty patients with OSA were included in the current study, and the prevalence of comorbidities and their association with the severity of OSA were determined. Results Out of 60 patients with OSA, 62% were males and 38% were females, and their mean apnea–hypopnea index (AHI) was 40.11 ± 25.78. Mild OSA was present in 15% of patients, moderate and severe OSA in 31.7 and 53.3%, respectively. Males had higher prevalence of severe OSA than females. The most prevalent comorbidities were obesity, which was seen in 70%, followed by hypertension in 63.3%, and depression in 56.7% of patients. Although these were more predominant in patients with severe OSA, the difference was not statistically significant. Conclusion The present study concluded OSA as significant risk factor for the emergence of comorbidities. Hence, patients with symptoms suggestive of sleep apnea should be assessed and treated early because lack of awareness of the disease and its associated comorbidities may result in increased mortality. How to cite this article M P, Sodhi MK, Bhatia C, et al. Prevalence of Comorbidities in Obstructive Sleep Apnea and Association with Disease Severity: A Descriptive Study. Indian J Respir Care 2024;13(3):152–157.

Background and aim Acute respiratory infection (ARI) is a leading cause of illness and mortality in children under five years old, especially in developing countries. The condition demands serious attention to reduce the disease burden. This study aimed to estimate the prevalence and associated factors of ARI in under-five children in rural Mysuru. Materials and methods A community-based cross-sectional study was conducted over 6 months, from January to June 2023, among 400 children aged 6 months to 5 years in rural Mysuru. Data were collected using the interview method using a semi-structured interviewer-administered proforma. Results The prevalence of ARI was reported to be 68.3%, with 65% of children experiencing at least one episode. Remarkably, children aged 1–3 years were most affected, with a prevalence of 45%. Notably, maternal education (31.2% with high school completion) and socioeconomic status (55.8% middle-class) played crucial roles. Environmental risk factors including ventilation, waste disposal, and water quality were implicated. Acute respiratory infection symptoms like fever, cough, and wheezing are statistically significant. Conclusion Acute respiratory infection is a critical problem that requires attention and should be addressed among under-five children. The findings highlight a significant prevalence of ARI, affecting 68.3% of children in the age group of under 5 years. This study underscores the urgency of addressing ARI among young children, emphasizing the roles of maternal factors, environmental measures, breastfeeding, and immunization coverage in reducing ARI incidence. How to cite this article Gangadhar LS, Shree A, Narayanan DKL. Prevalence of Acute Respiratory Infection among Under-five Children in a Rural Area of Mysore District. Indian J Respir Care 2024;13(3):182–187.

We present a unique case of pulmonary nontuberculous mycobacteria (NTM) infection caused by Mycobacterium fortuitum in a patient who had previously undergone successful treatment for tuberculosis (TB). Despite the eradication of Mycobacterium tuberculosis, the patient developed respiratory symptoms and imaging findings indicative of NTM infection. This case report highlights the importance of considering NTM as a potential pathogen in immunocompetent post-TB individuals, emphasizing vigilance in diagnosis and management. How to cite this article R A, S RR, M T, et al. Double Trouble: Pulmonary Nontuberculous Mycobacteria (Mycobacterium fortuitum) Unveiled in a Successfully Treated Tuberculosis Survivor: A Case Report. Indian J Respir Care 2024;13(3):200–201.

Introduction A bronchoscope is important medical equipment used for bronchoscopy, a procedure that allows visualization of the upper and lower respiratory tract. Utilization of equipment is an important aspect for optimal patient handling and quality of care. The utilization coefficient (UC) gives a picture of the level of utilization of the equipment, which can be optimally utilized, overutilized, or underutilized. Materials and methods A descriptive study was conducted in the respiratory medicine department of a tertiary care government teaching hospital for one month. The UC of the bronchoscope was calculated, taking into consideration the maximum hours it can be used in a day and the average hours it is used each day. Results The average time the bronchoscope is used per day came out to be 4 hours, and the maximum time the bronchoscope can be used per day is 5 hours. The UC came out to be 80%, thus indicating optimal utilization of the bronchoscope. Conclusion Results cater attention toward optimal utilization of equipment, which is an important factor frequently overlooked by management in the healthcare delivery system and can lead to losses by reducing yield. How to cite this article Suhaib M, Srivastava P, Bhardwaj ND, et al. Utilization Rate of Bronchoscope in Tertiary Care Hospital: An Evaluation from the Perspective of Operational Management. Indian J Respir Care 2024;13(3):172–175.

Aims and background India bears the brunt of both tuberculosis (TB) as well as diabetes patients globally, and either disease affects each other detrimentally, leading to increased morbidity and mortality; thereby, hampering the national and international policies and goals targeted in the control and prevention of these diseases. Hence, this study was done to determine the correlation between the sputum cartridge-based nucleic acid amplification test (CBNAAT) cycle threshold (Ct) values and glycosylated hemoglobin (HbA1c) levels at the point of diagnosing pulmonary tuberculosis (PTB). Materials and methods This study, conducted over a span of 6 months, followed a cross-sectional design. Patients diagnosed with PTB, confirmed by sputum CBNAAT, were enrolled in the study after screening them with the inclusion and exclusion criteria. The sputum CBNAAT Ct values were noted, and the average of the five probes labeled as A, B, C, D, and E was utilized to quantify the bacilli, reported as the mean Ct value. Semi-quantitative mycobacterial load results were categorized as follows—high (Ct values <16), medium (Ct values 16–22), low (Ct values 22–28), or very low (Ct values >28). The HbA1c (glycated hemoglobin) levels of the patients were estimated from a venous blood sample. Results Out of 136 study subjects, 61% were male participants with a mean age of 41 years. Among them, 23.5% (n = 32) were previously known diabetics. Additionally, 37.5% (n = 51) were newly detected diabetics based on HbA1c levels (cutoff 6.4) at the time of PTB diagnosis. Most patients had a low bacterial load (44.10%, n = 60). The high bacterial load group (26.5%, n = 36) had the lowest mean Ct value of 15.51, while the very low bacterial load group (8%, n = 8) had the highest mean Ct value of 31.47. The high bacterial load group also had the highest mean HbA1c level of 7.6, whereas the low bacterial load group had the lowest mean HbA1c level of 6.03. The Pearson correlation coefficient is −0.426, indicating a moderate negative correlation between the two variables. Conclusion This study found a moderate negative correlation between sputum CBNAAT Ct values and HbA1c levels in patients with pulmonary TB. This suggests that as HbA1c levels increase, the bacillary load also increases, as indicated by decreasing Ct values, and vice versa. Clinical significance According to our study, patients with poor glycemic control have a high bacterial load, predicting more severe disease. This finding may help guide treatment decisions and improve patient outcomes. How to cite this article C CK, L SB, J M, et al. Correlation between Sputum Cartridge-based Nucleic Acid Amplification Test–Cycle Threshold Values and Glycosylated Hemoglobin Levels in Patients with Pulmonary Tuberculosis. Indian J Respir Care 2024;13(3):158–162.

Aim and background A dysregulated immune response can produce acute lung injury and worsen clinical status of patient by causing organ dysfunction and severe pneumonia. Modulating the immune response can improve the outcome of illness and avoid treatment failures. Glucocorticoids are well-known natural inhibitors of inflammation that can be used as an adjunctive treatment; however, their use still remains controversial. Hence, we planned this study to look at the efficacy of steroids to reduce treatment failure among patients of severe community-acquired pneumonia. Materials and methods: This was a monocentric, single-blinded, randomized placebo-controlled trial, conducted in 55 patients admitted in Government Medical College and Hospital Sector 32, Chandigarh. Participants were enrolled after they met all inclusion and exclusion criteria over a period of 12 months from January 2023 till December 2023. After enrollment, they were randomized through a 1:1 ratio to receive injection methylprednisolone 0.5 mg/kg q12h for 5 days and placebo along with standard antibiotic therapy. Outcomes included assessment of treatment failure, length of hospital stay, and mortality. The collected data was analyzed with Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, version 26.0. Results In this study of 55 patients, 50 were included for analysis, with 3 leaving against medical advice and 2 withdrawing consent. Both groups had a mean age over 50 years. Initial hemodynamic stability was faster in intervention group (p = 0.025), but delayed stability was similar in both. Mortality during hospitalization (28 vs 40%; p = 0.37) and length of stay (6 days vs 8 days; p = 0.815) showed no difference. Early (57 vs 73%; p = 0.256) and late clinical stability (p = 0.572) were not significantly different. Likewise, early treatment failure (44 vs 64%; p = 0.156) and late treatment failure (18.18 vs 26.3%; p = 0.705) did not differ. Overall, primary and secondary outcomes did not show any statistically significant distinctions. Conclusion In treating severe pneumonia, the use of an adjuvant corticosteroid was found to be statistically equivalent to using an antibiotic alone in this trial. Nonetheless, the intervention group showed a discernible improvement in clinical indicators and a decrease in complications, duration of hospital stay, mortality, and treatment failure rate, all of which remained below the threshold of statistical significance. How to cite this article Dahra A, Sandeep VS, Singh K, et al. Efficacy of Corticosteroid Therapy in Severe Community-acquired Pneumonia: A Monocentric Single-blinded Randomized Placebo-controlled Trial from a Tertiary Care Center in North India. Indian J Respir Care 2024;13(3):176–181.

How to cite this article: Vyawahare CR, Ratnaparkhi MM, Athavale PV, et al. Leveraging Nutritional Interventions: A Silver Bullet to Aid in the Management of Tuberculosis. Indian J Respir Care 2024;13(3):217–218.

Introduction Nonresolving pneumonia (NRP) or slowly resolving pneumonia is a major concern among clinicians. The definition and approach toward diagnosis and management are unclear. Herein, we conducted a prospective observational study to analyze the comorbidities, etiology, and mode of diagnosis of NRP at our center. Methodology All subjects admitted with a diagnosis of NRP (who received at least 2 weeks of antimicrobial therapy without any clinical improvement) were enrolled in the study. Patients with poor general condition, hemodynamic instability, and uncooperative patients were excluded from the study. After noting clinical and demographic details, contrast-enhanced computed tomography (CT) scan was done for all patients. All subjects were assessed to undergo flexible bronchoscopy, image-guided sampling, surgical lung biopsy, or pleural fluid analysis based on the imaging findings on CT scan. The details of the mode of diagnosis and the yield of procedures were noted. Results We included 102 subjects; an infective etiology was diagnosed in 64 (62.7%) of the cases and 38 (37.2%) were diagnosed to be of noninfective etiology. Among the infections, pulmonary tuberculosis [21 (20.6%)] and invasive fungal diseases [20 (19.5%)] were the most common diagnoses. Diabetes mellitus (57.8%) and recent COVID-19 (26.5%) were the common comorbid conditions predisposing to infection. Among the noninfectious etiology, pulmonary adenocarcinoma was the most common diagnosis seen in 14 (13.7%) cases. Flexible bronchoscopy was most instrumental in obtaining the diagnosis as seen in 71 (69.6%) cases, followed by image-guided biopsy in 17 (16.6%) and surgical lung biopsy in 7 (6.9%) patients. Overall yield of bronchoscopy in our study population is 77.2% (71/92) and image-guided sampling is 94.4% (17/18). The infectious group had shorter disease duration, more comorbid illnesses, mucopurulent secretions on bronchoscopy, and higher mortality at 1 month as compared to noninfectious group. After adjusting the covariates, the presence of fever [odds ratio (OR) 12.75; 95% confidence interval (CI), 2.74–59.26] and recent history of COVID-19 (OR 12.29; 95% CI, 1.43–105.6) were independently associated with infectious etiology. Conclusion Infections, particularly tuberculosis and invasive fungal diseases, are the major causes of NRP. Diabetes mellitus is the predominant underlying comorbid illness, and recent infection with COVID-19 is an emerging risk factor for NRP. Flexible bronchoscopy and image-guided sampling, when used in rational approach, are helpful in establishing the diagnosis of NRP. How to cite this article Narahari NK, Kodati R, Korambatta D, et al. Profile of Nonresolving Pneumonia in a Tertiary Care Center in South India: A Prospective Study. Indian J Respir Care 2024;13(3):163–171.

Introduction Pleural effusion drainage in addition to antibiotics is used for the management of empyema and complex parapneumonic effusions (CPE). Fibrinolytics aid in drainage because fibrin adhesions create loculations in the pleural space. Although open thoracotomy and video-assisted thoracoscopic surgery (VATS) are the best therapeutic modalities, their widespread use is limited by operational risk and increased costs. Thus, intrapleural fibrinolytic therapy (IPFT) must be considered before more expensive and invasive techniques. Case description We present a case of a 10-year-old girl who presented with fever, dry cough, and loss of appetite for 2 weeks along with breathlessness for 1 week. Her chest radiograph revealed left-sided massive pleural effusion for which left tube thoracostomy was done. It was a tubercular, exudative lymphocytic effusion. The patient was advised to undergo thoracic surgery in the form of VATS with thoracotomy for failed tube drainage. Instead of subjecting her to an expensive and major surgical procedure, she was subjected to IPFT with three doses of streptokinase. There was complete resolution of the loculated pleural effusion, and she was discharged after 3 days. Conclusion Regardless of the etiology, IPFT is an affordable option for all kinds of loculated pleural collections and needs to be presented as the first choice, even when VATS is available. How to cite this article Gandhi RP, Dole SS, Barthwal MS. Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report. Indian J Respir Care 2024;13(3):212–215.

The coexistence of two conditions producing hypertrophic pulmonary osteoarthropathy (HPOA) is rare. In this case, the patient has pulmonary tuberculosis (PTB) and bronchogenic carcinoma, both of which can contribute to HPOA separately. A 69-year-old male presented with pain and swelling of wrist and fingers of both hands. The patient has a history of smoking. On examination, the patient had grade IV clubbing, minimal crepitations and wheeze on right side, and decreased breath sounds on left side. X-ray of the wrist showed new bone formation, and chest X-ray showed right upper lobe nonhomogeneous opacities and a left lower lobe mass lesion. Contrast-enhanced computed tomography (CECT) confirmed the same. Bronchial washing and sputum samples were sent for cartridge-based nucleic acid amplification test (CBNAAT) and came out as positive. Computed tomography (CT)-guided fine needle aspiration cytology (FNAC) from left lower lobe mass lesion revealed non-small cell lung carcinoma. It is quite rare for PTB and lung cancer to coexist. Though PTB rarely produces HPOA, this patient has HPOA with coexisting PTB and non-small cell lung carcinoma. It is more plausible to think HPOA is due to bronchogenic carcinoma than PTB. How to cite this article J M, Jacob R. A Case of Hypertrophic Pulmonary Osteoarthropathy in Coexistent Non-small Cell Lung Carcinoma and Pulmonary Tuberculosis. Indian J Respir Care 2024;13(3):197–199.