COVID-19 pandemic has been a global health concern since the beginning of 2020. Many individuals suffered and lost their lives, making it a considerable burden on the healthcare systems in their countries. Healthcare professionals worked beyond their limits to cater to the needs of the patients, working against the constraints of a workforce shortage. Many doctors and other allied health professionals also lost their lives. Although the medical and allied health education suffered during the pandemic, it has also provided respiratory therapists (RTs) several opportunities to prove themselves. There was a huge demand for RTs, and they were able to help inpatient management and save lives. RTs were also able to contribute to the capacity building of their juniors and other healthcare professionals. Hands.on work and the use of blended learning strategies during the pandemic proved to be a boon for respiratory therapy education and training. Ongoing updates on innovation, research, and new knowledge generated by the international community enhanced the learning of RTs. RTs became a recognized workforce during the pandemic, and their demand grew substantially. Overall, the COVID-19 pandemic offered the RTs opportunities to grow and evolve. This narrative review highlights the opportunities presented by the COVID-19 pandemic and its impact on the evolution of RT in India.

Introduction: Exudative pleural effusion is one of the most commonly encountered clinical conditions for pulmonologists. Sometimes, etiological diagnosis of pleural effusion is difficult despite cytological, biochemical, and microbiological tests and is then labeled as undiagnosed exudative pleural effusion (UPE). The present study aimed to assess the diagnostic yield and safety of closed pleural biopsy (CPB) in such patients with UPE. Materials and Methods: This was a hospital.based, interventional study conducted on 101 UPE patients for 2 years. All patients were subjected to CPB using Abrams needle. Pleural biopsy samples were subjected to histopathology, Ziehl-Neelsen staining, and tuberculosis (TB) culture. All the data, including demographic characteristics, pleural biopsy reports, and procedure complications, were recorded. Statistical analysis was performed using the SPSS software 10 and results were expressed in terms of means and percentages. Results: A total of 101 patients (68 males and 33 females with a mean age of 50.1 years) were subjected to pleural biopsy. Of 88 patients in whom adequate pleural tissue was obtained, diagnosis of malignancy and TB was made in 36 and 31, respectively, and pleural biopsy examination findings were nonspecific (acute/chronic inflammation) in 21 patients. The diagnostic yield of pleural biopsy was 76%. Minor complications were observed in ten patients. Conclusions: A pleural biopsy is a valuable diagnostic tool in UPE cases. Malignancy was the most common cause of exudative pleural effusion, followed by TB in our setup. Pleural biopsy should be considered in all patients with UPE

Introduction: Health.care providers on the front line who are involved in managing patients with COVID-19 are at risk of developing emotional stress and other mental health symptoms. It is imperative to study mental stability in these health.care providers, which helps take the necessary steps to improve mental health during the pandemic period. Aims and Objectives: This study aimed to study the perception of stress in health-care workers (HCWs) involved in managing COVID-19 patients during the first wave. Materials and Methods: This was a prospective cross.sectional study conducted from March 2020 to July 2020. After obtaining informed consent over the phone, the Google Form link was sent to participants whose app number and response were accepted until July 15th, 2020. Google Form consisted of patient demographic characteristics and ten.item Perceived Stress Scale (PSS). Two hundred and seventy.two responses were analyzed. Results: We contacted 470 HCWs, of which 272 (57%) response was obtained, of which 145 (53.3%) were females, and 127 (46.7%) were males. The mean age of the participants was 30.44 years (standard deviation = 5.01). The mean PSS score was 17.73 ± 5.33. Among participants, 136 (50%) were postgraduate students, 93 (34%) were nursing officers, and 43 (15.8%) were staff. Majority of HCWs, about 75.7% (206), had moderate stress, followed by low stress in 21.0% (57) and high stress in 3.3% (9). There was a statistically significant correlation between the perceived stress score and the total number of working days. Conclusion: The study conducted during the COVID-19 pandemic showed that three.fourths of HCWs had moderate stress, which has a significant impact on physical, mental, and psychological health. Females had more stress compared to male participants. Health-care providers in IP services had significant stress compared to HCWs in outpatient services.

Background: Occurrence of postpulmonary complications (PPCs) is common after thoracic incisions. Significant reduction in pulmonary functions reported in patients after median sternotomy is known to be associated with postoperative pain which potentiates risks for PPCs. Transcutaneous electrical nerve stimulation (TENS) is a low.frequency electrical current used for efficient pain modulation in managing various types of pain, including that after thoracic surgery. Aim: The aim of this study was to study the effect of TENS on Pain, Inspiratory Capacity, and Cough (PIC Score) in patients who have undergone median sternotomy. Materials and Methods: Thirty patients who underwent median sternotomy were randomly divided into control and experimental groups on the postoperative 1st day. Participants of the experimental group received TENS, and the control group received placebo TENS for 5 days. PIC Score was used as an outcome tool and was assessed at baseline (before commencement) and the endpoint (on the 5th day after the intervention). Results: Although both the groups showed improvements in PIC Scores, the experimental group showed superior results than the placebo group (P = 0.02). Conclusion: Conventional TENS effectively reduces pain and improves inspiratory capacity and coughing (PIC Score) in patients who have undergone median sternotomy.

Introduction: Physiotherapy and medical management have shown to be beneficial in managing COVID-19 patients. Prone positioning was maximally used in managing these patients, which helped improve ventilation. Crocodile breathing emphasizes diaphragmatic recruitment, decreases accessory muscle use, and triggers the body's relaxation response. The study aims to see the immediate effect of crocodile breathing versus prone positioning in COVID-19. Methods: Thirty participants who passed the eligibility criteria were randomly assigned into two groups. Group A was asked to perform standard of care treatment followed by prone positioning, and after a washout period of a day, they were made to perform standard of care treatment followed by crocodile breathing. Group B performed crocodile breathing on Day 1 and prone positioning on the next day. Outcome measures pulse rate, respiratory rate, rate of perceived exertion, oxygen saturation, single.breath count (SBC), and chest expansion. The patient's feedback was recorded immediately within 1 min pre and post.treatment on both days. Results: Significant improvement was seen in physiological parameters (P < 0.0001), chest expansion (P < 0.0001), and SBC (P < 0.0001) in both groups. However, crocodile breathing was seen to be more effective than prone positioning on SBC (P < 0.0001), rate of perceived exertion (P = 0.000), and chest expansion (P < 0.0001). Twenty.six out of 30 (86%) participants reported crocodile breathing was a more comfortable and better position to relieve dyspnea. Conclusion: Crocodile breathing effectively manages COVID-19 and can be safely incorporated into physiotherapy management for patients with COVID-19.

Introduction: Chronic obstructive pulmonary disease (COPD) is a disease of respiratory airflow obstruction. There are > 80 tools to measure various aspects of COPD patients well.being. This study aimed to evaluate the reliability and consistency of CAT and clinical COPD questionnaire (CCQ) and their correlation with St. George respiratory questionnaire (SGRQ). Methods: A prospective observational comparative study was conducted for 6 months in the pulmonology department of a tertiary care hospital. The following questionnaires were employed to evaluate the state of health of COPD patients: modified Medical Research Council (mMRC), COPD assessment test (CAT), CCQ, and SGRQ. Consistency and inter.rater reliability of CAT and CCQ scales was performed by taking into account the scores of four assessors. Results: Of the 52 patients included, 96% were male, and 4% were female. Cronbach's alpha was 0.620 (CAT score) and 0.861 (CCQ score). The percentage of patients with an mMRC scale of grade 0, 1, 2, 3, and 4 was 4%, 23%, 38%, 8%, and 27%, respectively. SGRQ showed a moderate correlation with CCQ (0.621) and CAT (0.652) scores. Conclusion: The psychometric properties of CAT and CCQ were consistent and satisfactory. Reliability and internal consistency of CAT and CCQ were good and can be employed easily for examining the health state of COPD patients.

Introduction: Mucormycosis is a life.threatening fungal infection caused by fungi belonging to the family Mucorales, and the fungus mainly responsible for infection in humans is Rhizopus oryzae. Recently, several cases of coronavirus disease 2019 (COVID-19).associated mucormycosis are being reported worldwide. Subjects and Methods: A retrospective observational study was conducted in the emergency department at a tertiary care hospital for 2 months. The primary objectives of this study were to assess the risk factors of post COVID-19 the signs and symptoms, toassess the relationship between steroidal usage and post-COVID-19 mucormycosis evaluating the treatment patterns. Results and Discussion: In the current study, 45 cases were examined. It was found that patients with comorbidities, especially diabetes mellitus, i.e., 80%, have more exposure to post-COVID-19 mucormycosis than any other comorbidity. It is also found that methylprednisolone is the major steroid used, accounting for 43% of the steroids used for the treatment of COVID. The treatment included the usage of lipophilic amphotericin B in 61% of the patients, which is associated with lipophilic posaconazole in 95% of the patients. Conclusion: Post-COVID-19 mucormycosis is a major threat to the individuals affected with COVID-19. The major risk factor is the presence of diabetes mellitus; therefore, proper measures must be undertaken in diabetic patients. Patient develops any symptoms related to the eyes, nose, face, lungs, and skin should seek a medical emergency to avoid chronic complications.

Background and Aim: Severe acute respiratory syndrome coronavirus 2 is a novel coronavirus that is responsible for the current pandemic. In earlier studies, loss of respiratory function had been observed in survivors. The degree of respiratory function loss and if any early intervention may reduce or prevent it remains an issue to be clarified. The study aimed to investigate the effects of pulmonary rehabilitation through a supporting device on COVID-19 patients during a follow.up period of 1 month. Materials and Methods: In this study, patients were selected among those who had applied to emergency service, were evaluated by a pulmonary medicine resident or specialist, and were required hospital admission. The admission began on March 29th, and the study concluded on June 1st. Respiratory exerciser and peak flow meters were provided to the patients for respiratory function testing. Results: Eighty.four patients admitted to the ward were evaluated for the study between these dates. Thirty.five patients were found suitable for the study. The median discharge Peak Expiratory Flow (PEF) value was 225 ml/min (180.285), and the median follow.up PEF value was 465 ml/min (312.515) with an absolute difference of 175 ml/min (85.250). No difference between absolute PEF values and percentages was seen between the control and study groups (P = 0.374 and P = 1.0, respectively). A negative correlation between the Charlson Comorbidity Index and follow.up PEF value was observed (P = 0.009). Conclusions: There was no difference in the utilization of respiratory exercise in the initial period of COVID-19 in our study. These results could be interpreted that COVID-19 patients with no respiratory disease history and low morbidity may not require respiratory exercise to return to basal respiratory function (ClinicalTrials ID: NCT04826731).

Introduction: Patients with chronic obstructive pulmonary disease (COPD) are often malnourished with resultant poor health.related quality of life (HRQoL). This study aimed to determine various anthropometric indices and the BODE index in stable COPD patients and correlate them with HRQoL using the St. George's Respiratory Questionnaire (SGRQ). Materials and Methods: A cross.sectional, observational study was done between August 2019 and September 2021 at a tertiary care hospital in 100 stable COPD patients. Results: Fifty-four males and 46 females with a mean age of 53± 11 years. Average body mass index (BMI) was 21.27 ± 2.62 kg/m2. The mean BODE index of the study participants was 4.37 ± 1.78. The anthropometric indices - triceps/scapular skin fold thickness, waist.to.hip ratio, and mid.upper.arm circumference did not correlate significantly with worsening Global Initiative for COPD (GOLD) stages (one.way analysis of variance [ANOVA] P > 0.05). There was a correlation between decreasing BMI and the worsening GOLD stage (one.way ANOVA P < 0.05). The anthropometric indices did not correlate with the BODE Index (Pearson Correlation coefficient P > 0.05). On linear regression analysis, higher GOLD stage, higher Modified Medical Research Council grade, and lower BMI correlated with higher SGRQ score. Conclusion: Stable COPD patients with low BMI and poor BODE index had poor HRQoL. Other anthropometric indices did not correlate with HRQoL.

Introduction: This retrospective study attempted to assess the recruitability of the lungs that were affected by acute respiratory distress syndrome (ARDS) due to COVID-19. This was done with the combined use of transpulmonary pressure monitoring (to limit the stress), measurement of end.expiratory lung volume (EELV) (to measure the actual volume gain and be within limits of strain), electrical impedance tomography (EIT), and compliance (to diagnose overdistension). Recruitment was judged clinically by an increase in the SpO2 values. Methods: Retrospective data from the charts and progress sheets were collected from 27 patients admitted to the intensive care unit (between February 2021 and June 2021) with a ratio of arterial Partial pressure of oxygen (PaO2 in mmHg) to fractional inspired oxygen (FiO2) <150 (i.e., PaO2/FiO2 <150) with a diagnosis of ARDS. The esophageal pressure was monitored using the polyfunctional nasogastric tube (Nutrivent.). The end.expiratory volume was measured using the Carescape R860 (GE Healthcare) by the nitrogen multiple breath wash.out/wash.in (EELV) at a positive end.expiratory pressure of 5. EIT measurements were performed using the Pulmo Vista 500. We performed a recruitment maneuver using the “staircase maneuver. Results: As per the results of our study, we found that almost 2/3rd (66.7%) of the patients affected with COVID lungs affected with ARDS were recruitable. Conclusion: The results of our study again make us believe that majority of COVID-19 lungs affected with ARDS may be recruitable in the earlier stage of the illness (within the 1st week of ARDS). Thus, in such patients, safe, monitored lung recruitment should be attempted to improve oxygenation rather than directly proning the patient, which is fraught with its own set of complications.

Introduction: Coronavirus disease 2019 (COVID-19) pneumonia is heterogeneous disease with variable effect on lung parenchyma, airways, and vasculature, leading to long.term effects on lung functions. Robust data of ferritin in bacterial infection are available, and now its role as an inflammatory marker in COVID-19 pneumonia during initial assessment and planning of treatment is evolving. Materials and Methods: Prospective, two.center, observational study conducted from July 2020 to May 2021, in MIMSR Medical College and Venkatesh Hospital Latur, India, included 1000 COVID-19 cases confirmed with reverse transcription.polymerase chain reaction. All cases were assessed with lung involvement documented and categorized on high.resolution computed tomography (CT) of the thorax, oxygen saturation, inflammatory marker, Ferritin at the entry point, and follow.up during hospitalization. Age, gender, comorbidity, and use BIPAP (bi-level positive airway pressure)/NIV (noninvasive ventilation) (BIPAP/NIV) and outcome with or without lung fibrosis as per CT severity were key observations. CT severity scoring was done as per universally accepted standard scoring tool as score <7 as mild, 7.14 as moderate, and score > 15 as severe affection of lung. Statistical analysis is performed using Chi.square test. Results: Age (<50 and > 50 years) and gender (male versus female) have significant association with ferritin in predicting severity of COVID 19 pneumonia (P < 0.00001) and (P < 0.010), respectively. CT severity score at the entry point with ferritin level has a significant association (P < 0.00001). Ferritin level has a significant association with the duration of illness (P < 0.00001). Comorbidities have a significant association with normal and abnormal ferritin levels, respectively (P < 0.00001). Ferritin level has a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement during treatment in critical care settings has a significant association with ferritin level (P < 0.00001). Timing of BIPAP/NIV requirement during the course of COVID-19 pneumonia in critical care settings has a significant association with ferritin level (P < 0.00001). Follow.up ferritin titer during hospitalization as compared to entry point normal and abnormal ferritin has a significant association in post-COVID lung fibrosis, respectively (P < 0.00001). Conclusions: Ferritin is easily available, sensitive, reliable, cost.effective, and universally acceptable inflammatory marker in COVID-19 pneumonia. Ferritin has a very crucial role in COVID-19 pneumonia in predicting the severity of illness and assessing response to treatment during hospitalization. Follow.up ferritin titer during hospitalization and at discharge can be used as early predictor of post-COVID lung fibrosis.

Context: Stone sculptors are more prone to many occupation.related lung diseases due to continuous exposure to dust particles generated in the workplace. All of these lead to impaired lung functions, which affects the quality of life. Objectives: The objective of this study is to assess the prevalence of respiratory symptoms and respiratory morbidity.related quality of life among stone sculptors. Methodology: This is a cross.sectional study among 125 stone sculptors in the rural areas of Mahabalipuram. Data regarding demographic variables, socioeconomic status, respiratory symptoms, quality of life using the St. George's Respiratory Questionnaire (SGRQ), and spirometry values (using pulmonary function test - mini spirometry) were collected and analyzed. Results: Among the study individuals, 33 (26.4%) had dyspnea, 25 (20%) had cough, 17 (13.6%) had sputum production, 12 (9.6%) had wheezing, 4 (3.2%) had chest pain, and 4 (3.2%) had hemoptysis. The age of the stone sculptors and duration of years of work, smoking, comorbidities and respiratory symptoms had a significant negative correlation with forced expiratory volume in one second/forced vital capacity ratio. The age of the stone sculptors, duration of years of work, duration of smoking, and duration of alcohol intake also had a significant positive correlation with the SGRQ score. Conclusion: Stone sculptors develop impaired lung functions and reduced quality of life based on the aforementioned factors. To prevent them from developing and worsening respiratory morbidity, periodic screening of individuals, effective use of personal protective equipment, and smoking control measures should be implemented and reinforced in the workplace.

In 2020, the World Health Organization described the SARS-CoV-2 virus (severe acute respiratory distress syndrome [ARDS]) for the first time. Millions of people were affected by the COVID virus worldwide, and many of them lost their lives too. Our center was also one health-care center that has played a significant role in managing severe ARDS patients secondary to COVID-19 infection. We want to outline the challenges faced by the respiratory therapist in managing a 24-year-old morbidly obese young male with severe ARDS due to COVID-19.

The utility of extracorporeal membrane oxygenation (ECMO) has gained significant attention over the past 25 years. ECMO has revolutionized the management of patients with refractory cardiac and respiratory complications in critically ill patients. We herewith present a case of a 26-year-old pregnant female patient with coronavirus disease.2019 and refractory hypoxemia, who was managed successfully on ECMO.

Varicella pneumonia is a serious complication of varicella infection. It occurs more often in adults than in children, although it is now infrequently seen since the introduction of the chickenpox vaccines. In immunocompetent adults, varicella pneumonia has a reported incidence of about 1 in 400 cases of varicella infection and it also carries significant mortality. Here, we report a case of varicella pneumonia in a young male who was immunocompetent and had no comorbidities. This case teaches us to be always careful and thorough with our clinical assessment and to think about the alternative etiologies for the cause of atypical pneumonia even during the times of the COVID-19 pandemic and not get swayed by the sheer numbers of coronavirus infections.

Coronavirus disease 2019 (COVID-19) survivors experience impaired pulmonary function, reduced muscle strength, and exercise intolerance affecting their activities of daily living. Literature has demonstrated a need for multi.disciplinary approach for their faster recovery. In a pandemic like situation where maintaining social distancing to reduce the risk of transmission had become a norm, telerehabilitation services came to a great rescue of both the patients and health.care providers. At present, there are not any established guidelines for rendering pulmonary rehabilitation through telerehabilitation (TR). Besides, it's effective implementation depends on numerous patient.centric factors such as age, hemodynamic stability, presence of comorbidities, availability of resources, and cognitive level of the patient. We hereby present the case of a 69-year-old female diagnosed with COVID-19 with prolonged hospital stay, having a history of multiple co-morbidities, focusing on the role of 12 weeks of TR in improving her functional outcomes.