Indian Journal of Respiratory Care

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Volume 13, Number 2, April-June 2024
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Jithin K Sreedharan

Leading with Excellence: A Remarkable Journey of Transformative Leadership and Unprecedented Accomplishments

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:5] [Pages No:73 - 77]

   DOI: 10.5005/jp-journals-11010-1109  |  Open Access |  How to cite  | 


Original Article

Praveen Raj S, Balaji Kalimuthu, Vignesh K

Evaluation of Diagnostic Markers Serum Angiotensin-converting Enzyme and Soluble Interleukin-2 Receptor Levels in Newly Diagnosed Cases of Sarcoidosis: A Case–control Study

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:5] [Pages No:78 - 82]

Keywords: High-resolution computed tomography thorax, Sarcoidosis, Serum angiotensin-converting enzyme, Soluble interleukin-2 receptor

   DOI: 10.5005/jp-journals-11010-1098  |  Open Access |  How to cite  | 


Background: Sarcoidosis is a chronic inflammatory disease that primarily affects the lungs and lymph nodes. The formation of noncaseating granulomas is one of the characteristics of this multisystem disorder of unknown etiology. The purpose of this study was to assess the value of soluble interleukin-2 receptor (SIL2R) and serum angiotensin-converting enzyme (SACE) levels in the diagnosis of sarcoidosis. Materials and methods: This case–control study recruited 37 patients with newly diagnosed pulmonary sarcoidosis and 31 healthy controls. All subjects had blood samples taken in order to determine their levels of SACE and SIL2R. Chest X-rays, spirometry with diffusion capacity for carbon monoxide (DLCO), and high-resolution computed tomography (HRCT) scans were performed on the sarcoidosis patients. Results: The mean values of serological parameters SACE and SIL2R were (79.49 ± 35.78 U/mL and 672.84 ± 408.86 pg/mL) in cases and (35.81 ± 9.45 U/mL and 300.03 ± 529.77 pg/mL) in controls, respectively. Differences were statistically significant for all these parameters, with a significantly higher mean in sarcoidosis patients. Sensitivity and specificity for SACE and SIL2R were 94.59, 93.55, 91.89, and 87.10%, respectively. Conclusion: This study suggests that SACE and SIL2R are useful markers for the diagnosis and monitoring of sarcoidosis. In sarcoidosis patients, SIL2R levels may also serve as a predictor of the disease progression and pulmonary function.


Original Article

Merve Y Senel, Serkan Kabacam, Merve Kasikci, Banu S Onder, Pelin OS Kiper, Gulen E Utine, Mehmet Alikasifoglu

Relationship between the Common Variants of the ADAM19, FAM13A, and IREB2 Genes and COPD Susceptibility and Severity

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:8] [Pages No:83 - 90]

Keywords: ADAM19, Chronic obstructive pulmonary disease, FAM13A, IREB2, Polymorphism

   DOI: 10.5005/jp-journals-11010-1103  |  Open Access |  How to cite  | 


Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease caused by both genetic predisposition and environmental factors. Objective: In this study, we aimed to investigate the relationship between the ADAM19, FAM13A, and IREB2 genes and COPD susceptibility and severity. Materials and methods: The clinical data of 110 patients with persistent airway limitation according to the COPD definition of Global Initiative for Chronic Obstructive Lung Disease (GOLD) were collected. The polymerase chain reaction (PCR) test was performed on the DNA extracted from peripheral blood and specific primers. Then, the patients were screened for the common variants of the ADAM19, FAM13A, and IREB2 genes using the BigDye terminator on an ABI Prism 3500 genetic analyzer. Results: Chronic obstructive pulmonary disease was significantly related to the IREB2 rs2568494 GA genotype. In the patients with the FAM13A rs2869967 TC genotype, there was a 3.758-fold increase in respiratory insufficiency risk and a 2.359-fold increase in the modified Medical Research Council (mMRC) dyspnea score 2 risk. Forced expiratory volume in 1 second (FEV1) was significantly lower in the patients with the ADAM19 rs1422795 AG genotype. The results of this study suggest that the IREB2 heterozygote variant is related to COPD. In patients with COPD with the FAM13A TC variant, the disease pattern is more symptomatic. We also determined that the ADAM19 heterozygote variant was not related to disease susceptibility, but the FEV1 ratio was lower. Conclusion: The ADAM19, FAM13A, and IREB2 genes may contribute to COPD pathophysiology. The associations between COPD and different gene variants investigated in our study are important for the identification of new pathways reflecting COPD heterogeneity.


Original Article

Arjun Kumar, Ashok K Janmeja, Balbir Singh, Monika, Nancy Chandna, Rohit Manchanda

Understanding Awareness of Patient Rights: A Cross-sectional Survey among Healthcare Workers, Patients, and Attendees

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:4] [Pages No:91 - 94]

Keywords: Attendants, Healthcare workers, Knowledge, Patient rights

   DOI: 10.5005/jp-journals-11010-1104  |  Open Access |  How to cite  | 


Introduction: In this modern era of medical science, “patient's rights” have become a pivotal component of the healthcare system. There are increasing gaps between patients’ expectations and the delivery of quality care. Therefore, knowledge of “patient's rights” among patients has received crucial value in medical science. Aim and objective: To assess the knowledge of “patient's rights” among healthcare workers, patients, and their attendants. Materials and methods: This was a cross-sectional survey conducted among the healthcare workers, patients, and their attendants admitted to the Department of Respiratory Medicine, Maharishi Markandeshwar Medical College and Hospital, Maharishi Markandeshwar University, Solan, Himachal Pradesh, India, for a duration of 6 months from January to June 2023. We assessed 300 participants’ knowledge of “patient's rights” based upon a standard questionnaire totaling 18 questions acquired from the “patient charter” Ministry of Health and Family Welfare (MoHFW) Government of India. Correct answers to >14 out of 18 questions were considered good knowledge. Results: Out of 300 participants, 156 (52%) were healthcare workers, and 144 (48%) were patients and their attendants. Overall, 96 (32%) participants were having poor knowledge of “patient's rights.” The majority, 60 (41.7%) of patients and their attendants, have poor knowledge of “patient's rights.” The lower level of education status was associated with poor knowledge of “patient's rights” among patients and attendants (p = 0.0024). The lower level of socioeconomic status was associated with poor knowledge of “patient's rights” (p = 0.0352). Conclusion: Our study noted poor knowledge about the “patient's rights,” especially among the patients and attendants followed by medical students and nurses. Appropriate steps are needed to improve awareness among patients and healthcare providers.


Original Article

Debasish Panda, Suresh Kumar Sundaramurthy, Lakshmi Ranganathan, Ramesh Venkataraman, Nagarajan Ramakrishnan, Raymond Dominic Savio

Reduced Diaphragmatic Thickness Index in Mechanically Ventilated Patients: Incidence, Risk Factors, and Impact on Weaning Outcome

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:6] [Pages No:95 - 100]

Keywords: Diaphragmatic dysfunction, Diaphragmatic thickness index, Diaphragmatic weakness, Mechanical ventilation, Spontaneous breathing trial, Weaning

   DOI: 10.5005/jp-journals-11010-1111  |  Open Access |  How to cite  | 


Background: Diaphragmatic weakness (DW) is common in an intensive care unit (ICU) and diaphragmatic thickness index (DTI) using ultrasound is used as a surrogate marker for DW despite many limitations. This study aims to identify the incidence and risk factors of reduced DTI (≤30%) among patients ventilated for >48 hours and its impact on outcome of first spontaneous breathing trial (SBT). Materials and methods: Single-center, prospective, observational study, conducted in a tertiary care ICU, over 4 months. Consecutive, eligible patients initiated on mechanical ventilation (MV) upon hospitalization and continued for >48 hours were included. Serial measurements of DTI were done once every 3 days until first SBT. Data pertaining to risk factors for DW and outcome of first SBT were documented. Results: Ninety-two patients were included in the final analysis of the study. DTI ≤30% was identified in 43.5% of patients. Sepsis on admission (p = 0.02) and use of neuromuscular blocking (NMB) agent infusion (p = 0.028) were significantly associated with reduced DTI. Failure of first SBT was observed in 82.5% of the patients with DTI ≤30%, whereas only 25% of those with DTI ≥31% were unsuccessful [relative risk (RR)—3.3; confidence interval (CI)—2.47–1.34]. Mean DTI was significantly higher among those who succeeded their first SBT (32.9 ± 8.9) vs those who failed (19.32 ± 11.89). Conclusion: Reduced DTI (≤30%) is common among patients mechanically ventilated for greater than 48 hours. Sepsis on admission and use of NMB agent infusion were identified as significant risk factors. DTI ≤30% was significantly associated with a failed first SBT.


Original Article

Manju Bala, Akhlesh Rajpoot, Dinesh C Punera, Suyash S Rathore

Prognostic Indicators for Prolonged Hospital Stay in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: An Observational Study

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:6] [Pages No:101 - 106]

Keywords: Acute respiratory failure, Chronic obstructive pulmonary disease, Noninvasive ventilation, Steroid therapy

   DOI: 10.5005/jp-journals-11010-1117  |  Open Access |  How to cite  | 


Aims and background: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is recognized as a major event in the natural history of COPD. Besides hurting lung function, survival, risk of readmission, and quality of life, it tremendously increases healthcare costs associated with hospitalization. Information on the time course and recovery from AECOPD is important in standardizing the length of treatment, planning appropriate follow-up, and decreasing the loss of working days of the patient. Hence, this study aimed to identify predictive parameters for length of hospitalization in AECOPD patients. Materials and methods: It was a prospective and longitudinal clinical-based descriptive study conducted at a tertiary care center in northern India. After applying the exclusion criteria and obtaining informed consent, 200 consecutive AECOPD patients were enrolled over 1 year. The Rome Proposal classifies AECOPD severity as mild, moderate, or severe, and the term prolonged length of hospital stay (LHS) refers to a stay lasting for 7 or more days. Results: The mean age of the 200 AECOPD patients was 63.9 ± 8.2 years, the mean LHS was 10.9 ± 5.2 days, and prolonged LHS (≥7 days) was seen in 140 (70%) patients. Advanced age, previous hospitalizations for AECOPD, arterial hypoxemia, the need for noninvasive ventilation (NIV), and severe AECOPD upon admission were found to be significantly correlated with the LHS (p < 0.05). However, only severe AECOPD upon admission was identified as an independent factor predicting prolonged hospitalization (p < 0.05). Conclusion: Older patients with a prior hospitalization for AECOPD, arterial hypoxemia, severe exacerbation of COPD, and need for NIV at the time of admission are more likely to have a longer hospitalization.


Original Article

Tonio P Agius, Kimberley Sevasta, Anabel Sciriha

Utilizing Muscle Energy Techniques for Biomechanical Changes in Chronic Obstructive Pulmonary Disease: Variations in Outcomes Based on Global Initiative for Chronic Obstructive Lung Disease Classification

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:6] [Pages No:107 - 112]

Keywords: Activities of daily living, Chronic obstructive pulmonary disease, Global Initiative for Chronic Obstructive Lung Disease Classification, Muscle energy techniques

   DOI: 10.5005/jp-journals-11010-1116  |  Open Access |  How to cite  | 


Background: Muscle energy techniques (METs) are manipulative interventions under current investigation for their impact not only within the musculoskeletal domain, but also in chronic obstructive pulmonary disease (COPD) patients. Previous research reported beneficial effects from a 4-week MET program on pulmonary function, functional capacity, and daily activities. Patients diagnosed with COPD are categorized using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, to guide tailored treatment regimens for different COPD phenotypes. Given positive outcomes from the MET program across all COPD classifications, investigating outcomes with the different traditional GOLD stages seemed warranted. Materials and methods: A parallel-group, randomized controlled trial was adopted. A total of 108 participants with COPD were recruited and randomly assigned to the intervention or control group. All patients were classified by the GOLD classification. The intervention group received MET interventions, three-times weekly for 4 consecutive weeks, while the control group continued with their standard medical treatment. The study is clinically registered ( identifier: NCT04773860). Results: All 108 patients completed the program, showing significant improvements across all three GOLD classifications. A significant difference in forced expiratory volume in 1 second (FEV1) was reported across the three GOLD classifications at both time points (p < 0.001). The changes observed in forced vital capacity (FVC) measures displayed significant differences at week 0 when comparing all three groups (p = 0.039). No statistically significant differences were observed in the other outcome measures. Conclusion: A 4-week MET program resulted in more significant improvements in lung function measures among more severe COPD patients, whereas no substantial improvements were observed in chest measurements, activities of daily living (ADLs), or exercise tolerance tests when examining the different GOLD stage groups. Clinical significance: This study shows benefits of a 4-week MET intervention period on patients suffering from COPD, which led to statistically significant improvements resulted within the pulmonary function measures, chest expansion and ADL performance, and improvement in walking distance. All these outcome measurements provide evidence that this technique can be an effective treatment which can be used as an adjunct with other nonpharmacological physiotherapeutic treatments offered to these patients. Analysis per GOLD classification did not result in any differences between the groups based on COPD severity.



Janmejaya Samal

A Short Narrative Review on the Delays in Tuberculosis Care in Odisha

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:4] [Pages No:113 - 116]

Keywords: Consultation delay, Diagnosis delay, Health system delay, Patient delay, Total delay, Treatment delay

   DOI: 10.5005/jp-journals-11010-1115  |  Open Access |  How to cite  | 


Early diagnosis and prompt treatment are definite steps toward tuberculosis (TB) elimination efforts; however, the same is greatly affected by delays in the TB care cascade. The delay, on the other hand, depends on the factors related to both sides of the health system, the supply and the demand side or the patient and the health system side. A review was carried out to understand different types, durations, and factors associated with delays in TB care among different population groups in Odisha. PubMed and Google Scholar search engines were used for searching relevant literature using the search string “Tuberculosis” AND “Delay” AND “Odisha.” Additionally, articles from cross-references were selected, with final inclusion of four studies for this review. Of the four studies, two articles each are based on secondary research and primary research. The secondary researches are based on Nikshay portal data, and primary researches are cross-sectional studies. Two studies were conducted in the tribal district of Rayagada, and one each included a sample from Cuttack to Mayurbhanj, with one pan-Odisha study. The retrospective observational registry-based cohort study among 47,831 TB cases across the state reported that 7.6% of cases were initiated on treatment after 14 days of diagnosis. The retrospective cohort study conducted in Cuttack and Rayagada district reported treatment delay of >15 days among 20% of the cases and median delay of treatment initiation of 14 days. The cross-sectional study in Rayagada reported that 62.2% of the patients reported to the designated microscopic centers (DMCs) after a month of the onset of symptoms. During recent days, the situation has improved; however, efforts must be directed toward improving knowledge and awareness about TB and its services among the tribal population, thereby improving health-seeking behavior and reducing delays.



Sanya Jain, Sana Ahuja, Sufian Zaheer

Neuroendocrine Tumor of Larynx—A Rare Entity: A Case Report

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:4] [Pages No:117 - 120]

Keywords: Case report, Grade, Larynx, Neuroendocrine carcinoma, Neuroendocrine tumor, Supraglottis, Synaptophysin

   DOI: 10.5005/jp-journals-11010-1105  |  Open Access |  How to cite  | 


Neuroendocrine laryngeal neoplasms are uncommon and comprise only 1% of all laryngeal neoplasms. These tumors are characterized by cells showing various degrees of pleomorphism that are arranged in nests and trabeculae containing neurosecretory granules, which show immunohistochemical positivity for synaptophysin, chromogranin, and neuron-specific enolase (NSE). Here, we present a rare case of neuroendocrine tumor (NET) grade III of the supraglottic region. The patient presented with a change in voice for 3 years and difficulty in swallowing solid and liquid both for the last 4 months. Histopathological examination showed a lobular architecture with cells exhibiting moderate pleomorphism and finely stippled chromatin. In immunohistochemistry (IHC), these cells showed positivity for synaptophysin and chromogranin with a Ki-67 index of 25%, thus confirming the diagnosis of NET, grade III.



Rahul Gupta, Sukhjinder P Singh, Arjun Kumar

A Rare Case of Contarini's Syndrome: A Diagnostic Dilemma

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:3] [Pages No:121 - 123]

Keywords: Carcinoma breast, Case report, Contarini's syndrome, Pleural effusion

   DOI: 10.5005/jp-journals-11010-1106  |  Open Access |  How to cite  | 


Presence of pleural effusions bilaterally are frequently experienced in clinical practice. Most of the pleural effusions having bilateral involvement have similar causes. The occurrence of bilateral pleural effusion with various causes for each side, also known as Contarini's syndrome, is rare. Here, we present the interesting case of Contarini's syndrome. Herein, we present the exceptional case of Contarini's syndrome, in a 53-year-old female of carcinoma breast, who developed bilateral pleural effusion of different etiology on both sides. Finally, we conclude that Contarini's syndrome is an uncommon entity. Pleural fluid aspiration from each side for bilateral effusion should be performed to investigate the etiology of bilateral pleural effusion in cases of uncertainty regarding alternate diagnosis.



Venkat Raj, Deepak Shah, Mohit Bhatia, Munesh K Gupta, B Gowthami, Vijay Kumar, Subham Sahoo, Murli D Saini, Ratesh Buhlan

Silent Invader—Unrevealing Lethal Encounter with Pulmonary Mucormycosis: A Rare Case Report

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:4] [Pages No:124 - 127]

Keywords: Broad aseptate hyphae, Case report, Endobronchial lung biopsy, Invasive course, Klebsiella pneumoniae, Liposomal amphotericin B, Multidisciplinary approach, Pulmonary mucormycosis, Reverse halo sign, Salvage

   DOI: 10.5005/jp-journals-11010-1110  |  Open Access |  How to cite  | 


A 61-year-old male having type 2 diabetes presented in the chest outpatient department with complaints of cough with expectoration, fever for 20 days, coughing out blood, and shortness of breath for 10 days. High-resolution computed tomography (HRCT) of the thorax revealed cavity consolidation in the left upper lobe showing reverse halo sign. Moreover, broad aseptate hyphae branching at right angles were observed in the potassium hydroxide (KOH) wet mount of bronchoalveolar lavage (BAL) sample, suggesting Mucorales. We labeled the case as pulmonary mucormycosis and treated with liposomal amphotericin B with correction of hyperglycemia. The patient initially responded well; however, he succumbed later due to the invasive course of the disease.



Kundan Mehta, Manosri Mandadi

Syndrome of Inappropriate Antidiuretic Hormone and Antituberculosis Treatment-induced Hepatitis: A Case Report

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:4] [Pages No:128 - 131]

Keywords: Antituberculosis treatment, Case report, Hepatitis, Hyponatremia, Syndrome of inappropriate antidiuretic hormone secretion, Tuberculosis

   DOI: 10.5005/jp-journals-11010-1112  |  Open Access |  How to cite  | 


Pulmonary tuberculosis (PTB) is a widespread respiratory infection predominantly found in developing countries, known for its high mortality and morbidity rates. The standard initial treatment for drug-sensitive PTB involves a 2-month regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE), followed by 4 months of isoniazid, rifampicin, and ethambutol (HRE). Hepatitis is a prevalent side effect linked to this treatment, emphasizing the need for close monitoring of liver enzymes at the beginning of the regimen. Hyponatremia, a common metabolic abnormality, is frequently observed in tuberculosis (TB) patients. We present a case of a 54-year-old female with drug-sensitive PTB who developed treatment-induced hepatitis and presented with unresponsive hyponatremia. Extensive investigations and radiological examinations revealed no structural anomalies. Laboratory results pointed to elevated serum antidiuretic hormone (ADH) levels, ultimately leading to the diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) due to ectopic ADH production.



Anand Rajendran, Nabishabanu Razak Ali, Ezhilvizhi Manikandan, Jeeva Rekha Balaji, Vinisha Ravichandran

Unveiling the Varied Faces of Melioidosis: A Case Series with Diverse Pulmonary Presentations

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:4] [Pages No:132 - 135]

Keywords: Acute respiratory distress syndrome, Burkholderia pseudomallei, Case report, Empyema, Lung abscess, Mediastinal lymphadenopathy, Melioidosis

   DOI: 10.5005/jp-journals-11010-1102  |  Open Access |  How to cite  | 


Melioidosis, caused by the bacterium Burkholderia pseudomallei, is known for its protean clinical manifestations. It can manifest as acute, subacute, or even chronic presentation. While commonly associated with septicemia and localized infections, pulmonary involvement can present with a spectrum of variable patterns. This case series aims to shed light on the diverse pulmonary presentations of melioidosis, highlighting the challenges in diagnosis and management.



Anand Rajendran, Thoupikka M, Maria L Rashmi, Ananthi M, Sneha Joshi

Case Series of Kartagener Syndrome: A Rare Genetic Disorder with Variable Pulmonary Presentation

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:4] [Pages No:136 - 139]

Keywords: Bronchiectasis, Case report, Immotile cilia, Infertility, Kartagener syndrome, Pneumothorax

   DOI: 10.5005/jp-journals-11010-1107  |  Open Access |  How to cite  | 


Kartagener syndrome (KS) is a rare autosomal recessive genetic disorder characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. This case series presents three unique cases of this rare entity—a middle-aged man with secondary spontaneous pneumothorax, a case of a young female with infertility, and a third of an infertile middle-aged female with type 2 respiratory failure. We also highlight the importance of KS with varied clinical presentation, diagnostic challenges, and management strategies in different patients.



Anirudha Katipalla, Preethiraj Ballal, Nandakishore Kumbarkoppal Shivanna

Areca Nut Husk: A Burning Issue?

[Year:2024] [Month:April-June] [Volume:13] [Number:2] [Pages:2] [Pages No:140 - 141]

Keywords: Chronic obstructive pulmonary disease, Environmental tobacco smoke exposure, Indoor and outdoor environment, Respiratory health, Risk factor

   DOI: 10.5005/jp-journals-11010-1108  |  Open Access |  How to cite  | 


Biomass fuel exposure has been one of the leading causes of many respiratory diseases, including chronic obstructive pulmonary disease (COPD). In a diverse agriculture-driven country like India, the major substances used as biomass fuels are the by-products of agriculture, which become locally available for use, and hence, this varies according to regional availability. This article tries to explore one such material, a by-product of the commercialized crop of areca nut, its husk as a biomass fuel. The Malabar coastal region of South India is a major producer of areca nut, and burning the areca nut husk as biomass fuel is a significant etiological factor for respiratory health in the population of this region. There is insufficient scientific evidence on its impact on the various aspects of human health, most importantly respiratory disorders. Hence, this is an attempt to incite the scientific community to develop robust evidence for the future.


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