Indian Journal of Respiratory Care

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2023 | January-March | Volume 12 | Issue 1

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EDITORIAL

Snehali Majumder

Interpretation of p-value: The Correct Way!

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:2] [Pages No:1 - 2]

Keywords: Interpretation, Null hypothesis, p-value

   DOI: 10.5005/jp-journals-11010-1026  |  Open Access |  How to cite  | 

Abstract

The probability value (p-value) is used in hypothesis testing to assist in determining if the null hypothesis should be rejected. In a practical setting, the p-value helps to determine if an experiment is conducted and then compares the outcomes to what random chance may yield. In order to do it, researchers state a “null hypothesis” that they want to disapprove. Many researchers consider the p-value to be the essential summary of statistical analysis of their research data. Although it is undeniable that p-values are a very useful method for summarizing study results, it is also undeniable that p-values are frequently misused and misunderstood. Therefore p-value must be carefully interpreted based on the study design, sample size, comparability of study groups, and appropriateness of statistical tests. The statistically significant p-value should not be the sole criterion for accepting or rejecting the conclusions of any report or publication. Proper critical appreciation of research publications is a mandatory requirement before making clinical decisions based on them

592

Original Article

Kaushick Mishra, Asis Manna, Ram Mohan Roy, Yogiraj Roy, Koushik Choudhury

Therapeutic Efficacy of Ivermectin in Novel Coronavirus Disease-2019 Patient Admitted at the Ward of a Tertiary Care Hospital: A Retrospective Study

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:5] [Pages No:3 - 7]

Keywords: Infectious disease, Ivermectin therapy, novel coronavirus disease-2019, severe acute respiratory syndrome coronavirus-2

   DOI: 10.5005/jp-journals-11010-1009  |  Open Access |  How to cite  | 

Abstract

Objective: An observational, retrospective, institution-based study to observe the pattern of ivermectin use related to patients’ characteristics. Methods: Patient data including short-term diagnosis, investigations done, and drug usage data were captured in a predesigned, structured case report form; and suspected adverse events were recorded in the standard suspected adverse drug reaction reporting form recommended by the “Central Drug Standard Control Organization,” India. The study was for a period of 7 months from August 01, 2020, to February 28, 2021. A total of 4,552 patients were recruited in this study and followed up till their discharge or death. The comparison was made between not given and given of ivermectin among patients. Results: Data were summarized by routine descriptive and statistical analysis. The mean age (years), length of stay (days) onset from hospitalization, pulse rate, systolic blood pressure (SBP), and temperature did not show significant change. However, respiratory rate was found to decrease significantly (p < 0.001), and oxygen saturation (SpO2) was found to increase significantly (p < 0.001) in the ivermectin-treated group. It was also observed that a positive correlation with a highly significant value (p < 0.000) between age (years), length of stay (days) onset from, pulse rate, SBP, and temperature and ivermectin usage while a negative correlation with highly significant value (p < 0.000) between SpO2 and ivermectin usage was obtained. Conclusion: As per the studied parameters, a significant correlation was observed in combinations of the treated and untreated groups. Further research suggested the dose-dependent efficacy of ivermectin usage in the novel coronavirus disease-2019 patients.

656

Original Article

Madhanmohan Kalyanasundaram, Sivaraja Subramaniam, Allwyn Vijay Gowrishankar

Clinical Profile of Patients with Immune Reconstitution Inflammatory Syndrome in Human Immunodeficiency Virus/Tuberculosis Coinfection and their Outcome: A Prospective Observational Study

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:4] [Pages No:8 - 11]

Keywords: Acquired immunodeficiency syndrome, Acquired immunodeficiency syndrome-related opportunistic infections, Immune reconstitution inflammatory syndrome, Tuberculosis

   DOI: 10.5005/jp-journals-11010-1001  |  Open Access |  How to cite  | 

Abstract

Introduction: Antiretroviral therapy (ART) is a life-saving treatment for the human immunodeficiency virus (HIV). However, the starting of ART is often complicated by immune reconstitution inflammatory syndrome (IRIS) in tuberculosis (TB). This study was done to examine the clinical profile of patients with IRIS in HIV-TB coinfection and their outcomes. Materials and methods: A prospective observational study was conducted at the Government Hospital of Thoracic Medicine, Chennai, Tamil Nadu, India, from January to December 2013. Patients diagnosed to have HIV and TB coinfection, those on anti-tuberculosis therapy (ATT) and ART, patients with paradoxical IRIS, and ART-naïve patients were included in the study. A total of 230 patients were studied and followed up for 1 year. Clinical examination and chest X-rays, sputum smear for acid-fast bacillus (AFB), baseline CD4 count, ultrasonogram of the abdomen, routine blood investigations, and other necessary parameters required to determine IRIS TB in HIV/TB coinfected patients were taken. Results: Among the 230 HIV patients studied, 74.3% were males, and the mean age was 39.01 ± 9.60 years. The incidence of IRIS was 20.9%, and the mortality rate was 25% among them. Oral candidiasis was the most common opportunistic infection (37.8%). Among IRIS patients, 62.5% had stage III clinical disease. Conclusion: The time of starting ART is critical to reducing IRIS-associated morbidity. Improved knowledge of the pathophysiology of IRIS will enable better diagnostic modalities and targeted treatments to be developed.

384

Original Article

K Anirudha, BL Shashi Bhushan, KU Vivek, AS Deepa

Computed Tomography Thorax Patterns in the Patients of Chronic Kidney Disease with Microbiologically Confirmed Coronavirus Disease-2019: An Experience from a Tertiary Care Hospital

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:5] [Pages No:12 - 16]

Keywords: Computed tomography, coronavirus, coronavirus disease-2019, ground-glass opacities

   DOI: 10.5005/jp-journals-11010-1007  |  Open Access |  How to cite  | 

Abstract

Introduction: A retrospective study aimed at analyzing the patterns in the CT scans of patients of CKD infected with COVID-19 in the period of two months. We reviewed the CT scans for the pattern of Lung involvement, number of lobe involved, distribution of the lesions and characteristic appearances, along with other coexisting features. Methodology: After consent, we studied the parameters of interest among the patients admitted in the dedicated COVID-19 hospital in Bengaluru, Karnataka, who were admitted during the months of October and November 2020. Each CT scan was reported by in-house radiologist and results were analyzed. Results: We found that of the 92 CKD patients, 51 had got a CT thorax done, out of which 45 had lung parenchymal involvement of COVID-19; of which 44 were bilateral. 26 of the patients had only peripheral lesions and 19 had both central and peripheral distribution. The most common finding was GGOs occurring in 43 of them while 30 of them had GGOs with consolidation. This study shows that the CT patterns in patients of CKD with COVID-19 involves mainly peripheral distribution of lesions with majority involving >2 lobes, with GGOs being most common finding; similar to those without CKD, but the incidence of pleural effusions and mediastinal lymphadenopathy is slightly higher, possibly because of coexistent comorbidities contributing to the same. Conclusion: We conclude that though some patients with CKD and COVID-19 can have a normal lung, the involvement of lungs is more severe and extensive in distribution, implying a more severe involvement of the lung. Hence, further Studies are required on larger population to ascertain the findings and further resources should be allocated for the benefit of this significantly vulnerable patients in this era.

417

Original Article

Ruchi Arora Sachdeva, Litika Verma, Lokesh Parashar, Manas Kamal Sen, Kamran Chaudhary, Harshita, Avinash Kumar, Amrita Swati

Impact of COVID-19 Coinfection on Management of Tuberculosis Patients Registered at DOTS Center in a Tertiary Care Hospital

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:6] [Pages No:17 - 22]

Keywords: Antituberculosis treatment, Coronavirus disease 2019, Directly observed therapy, National tuberculosis elimination program

   DOI: 10.5005/jp-journals-11010-1000  |  Open Access |  How to cite  | 

Abstract

Introduction: This study was conducted to determine the impact of coronavirus disease 2019 (COVID-19) and the ensuing lockdown on tuberculosis (TB) management undergoing treatment under the National Tuberculosis Elimination Program (NTEP) and vice-versa. Aims: To study (1) the occurrence of COVID-19 and its severity among patients suffering from TB and (2) the impact of a pandemic on TB management under NTEP. Materials and methods: A retrospective observational study was conducted in patients registered at Directly observed therapy short-course (DOTS) center from 1st April 2020 to 31st July 2021 at ESIC Medical College and Hospital, Faridabad, Haryana, India, using a semi-structured predesigned questionnaire administered telephonically. Results: Out of 387 TB patients registered at the DOTS center, 191 participated in the study. The occurrence of COVID-19 in patients with TB was 10 (5.2%), of which five (50%) were symptomatic; four (40%) had pulmonary TB, and six (60%) had extrapulmonary TB. Nine (90%) patients had mild and one (10%) moderately severe disease requiring hospitalization. Amongst 191 patients, 29 (15.2%) missed anti-TB treatment (ATT); 15 (51.7%) could not access the DOTS center due to restrictions, and seven (24.1%) due to personal reasons, eight (27.5%) forgot to take medication, and one (0.34%) migrated elsewhere. Conclusions: The occurrence of COVID-19 in patients with TB was found to be 5.2% in this study. The severity of COVID-19 was mostly mild and the mortality rate in patients with a coinfection of TB and COVID-19 was 10%. The COVID-19 pandemic had a negative impact on TB management under NTEP due to the imposed lockdown. The limitation of this study was the small sample size.

445

Original Article

Müfide Arzu Ozkarafakili, Adem Melekoğlu, Ertuğrul Altinbilek

Clinical Evaluation of Chronic Obstructive Pulmonary Disease Patients Hospitalized with COVID-19 Pneumonia

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:7] [Pages No:23 - 29]

Keywords: Chronic obstructive pulmonary disease, Coronavirus disease 2019, Mortality

   DOI: 10.5005/jp-journals-11010-1006  |  Open Access |  How to cite  | 

Abstract

Background: Coronavirus disease 2019 (COVID-19) has been a challenging viral respiratory tract infection since 2019 and may contribute to higher mortality in patients with chronic obstructive pulmonary disease (COPD). Methods: We analyzed the clinical data of 98 patients hospitalized with a diagnosis of COVID-19 and who had a previous diagnosis of COPD. They are grouped regarding GOLD ABCD stages, reported as follows whether in pandemic wards or intensive care units (ICU). The clinical outcomes were noted as a live hospital discharge or inhospital mortality. Results: A total of 76 patients (77.6%) were in the pandemic wards, 22 (22.4%) were in the ICU. Around 81 (82.7%) patients survived, 17 (17.3%) were deceased. We grouped them as GOLD A and GOLD B and GLOD C, and GOLD D. Procalcitonin (PCT) level was higher and arterial oxygen partial pressure (PaO2 in mm Hg) to fractional inspired oxygen (PaO2/FiO2) level was lower in the group of GOLD C and GOLD D than in GOLD A and GOLD B (p < 0.005). There was no statistically significant difference in inhospital mortality between these two groups (p = 0.098). While in the univariate model, hemoglobin (Hgb), urea, troponin, PCT, PaO2/FiO2, saturation%, and respiratory rate was observed to be significantly different; in the multivariate model, only a significant independent (p < 0.05) effect of PaO2/FiO2 were observed in distinguishing patients who survived or deceased. Conclusion: Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD groups are staging COPD patients in favor of predicting hospitalization and mortality. However, when COPD patients are hospitalized with COVID-19 pneumonia, different clinical factors and indices should be considered due to the heterogeneity and complexity of COPD.

396

Original Article

Manthan H. Purohit, Megha Sandip Sheth

Comparison of Peak Expiratory Flow Rate and Functional Capacity of COVID-19 Survivors with Age-matched Healthy Individuals

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:30 - 32]

Keywords: COVID-19, Functional capacity, Peak expiratory flow rate, Six-min walk test

   DOI: 10.5005/jp-journals-11010-1011  |  Open Access |  How to cite  | 

Abstract

Background: Much of the importance of COVID-19 treatment has been given to acute care of the problems. Since millions of people are recovering from COVID-19 infection, it becomes a need to investigate whether capability of performing tasks and activities has been affected and/or any residual deficits are present or not. Aims and objectives: This study aimed at comparing COVID-19 survivors with healthy individuals in pulmonary and aerobic capacity parameters by using peak expiratory flow rate and six-minute walk distance as objective measures. Materials and methods: Comparison was done between two groups, one with history of COVID-19 (Group A) and another without history of COVID-19 (Group B), both males and females, who belong to age group of 40–65 years were included. Result: Mean PEFR for group A (374.8 ± 114.27) and for group B (364 ± 70.23) L/min was found. Mean six-minute walk distance for group A (392.28 ± 99.15) and for group B (408.99 ± 97.96) meters was seen. Unpaired t-test result showed non-significant result for both the outcome measures (PEFR, p = 0.689, CI = –43.14 to 64.74 and 6-min walk test (6MWT), p = 0.565, CI = –72.20 to 39.89). Conclusion: There is no significant difference in PEFR and functional capacity found among individuals with and without history of COVID-19 infection.

407

Original Article

Anjaly K Chandrakumar, Jacob Baby, Elizabeth Sunila Chakkalakkal Xavier, Praveen Valsalan, Rohith Puthanveettil

Correlation Between Ultrasonographic Evaluation of Diaphragm Excursion, Thickness and Spirometry in COPD patients: A Case-Control Study

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:5] [Pages No:33 - 37]

Keywords: Chronic obstructive pulmonary disease, Diaphragmatic paralysis, Forced expiratory volume 1, Forced vital capacity, Spirometry, Ultrasonography

   DOI: 10.5005/jp-journals-11010-1027  |  Open Access |  How to cite  | 

Abstract

Background: Weakness of the diaphragm is associated with dyspnea and exercise intolerance and affects survival in chronic obstructive pulmonary disease (COPD) patients. The present study aimed to evaluate diaphragm excursion, and thickness using ultrasonography (USG) and spirometry values in patients with COPD, correlate these values and compare them with healthy controls. Methodology: This case-control study was conducted in a tertiary care center in South India for 1 year. A total of 70 patients with COPD and 70 healthy controls were recruited. Data were collected and statistically analyzed. Results: The absolute value of forced expiratory volume 1 (FEV1) and the percentage of predicted FEV1, forced vital capacity (FVC), and FEV1/FVC was significantly lower in COPD patients (p < 0.0001). Diaphragm excursion at normal inspiration, deep inspiration, and while sniffing was significantly lower in COPD patients (p < 0.01). Diaphragm thickness at end-inspiration, end-expiration, and diaphragm thickness fraction (DTF) was significantly lower in COPD patients compared to normal healthy subjects (p < 0.01). Conclusion: A mild positive correlation was found between diaphragm excursion at normal inspiration and FEV1. There was a strong correlation between FEV1 and diaphragm excursion during deep inspiration and sniffing. A linear equation was developed to calculate FEV1. FEV1 = 2.99 – (0.042 × age) + (0.224 × deep inspiration) + (0.015 × sniffing). This could predict risks for any major surgeries, decide on treatment options for COPD patients, and can be used for prognosis and follow-up while the patient is on inhaler therapy.

616

Original Article

Rahul Kumar Gupta

Study on Tuberculosis Treatment and Drug Resistance Testing in a Tertiary Care Center in Central India

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:4] [Pages No:38 - 41]

Keywords: Directly observed treatment short course, National tuberculosis elimination program, Nondirectly observed treatment short course, Revised national tuberculosis control programme, Tuberculosis, Xpert mycobacterium tuberculosis/cartridge-based nucleic acid amplification test/Trunat

   DOI: 10.5005/jp-journals-11010-1004  |  Open Access |  How to cite  | 

Abstract

National TB Elimination Program (NTEP) in India has planned for free of cost diagnosis and treatment for tuberculosis (TB) patients. This study is carried out to find out the deficiencies in treatment prescribed by practitioners, whether they were as per NTEP guidelines or not, and to assess the use of cartridge-based nucleic acid amplification test (CBNAAT) by practitioners for the detection of rifampicin resistance as per the current guidelines. Aims and objectives: This study was conducted to see the deficiencies in treatment prescribed by practitioners, whether they were as per NTEP guidelines or not, and to assess the use of CBNAAT by practitioners for the detection of rifampicin resistance as per the current guidelines. Materials and methods: The doctor's prescription of a total of 199 patients who visited the outpatient department (OPD) were assessed, and data was collected as per inclusion and exclusion criteria. Results: Out of the total 199 prescriptions, 83.4% of patients were prescribed antitubercular treatment (ATT) under directly observed treatment short course (DOTS), while in the remaining 16.6% of patients non-DOTS ATT [57% prescribed fixed dosage combination (FDC) and 43% prescribed individual drug] were prescribed by practitioners. CBNAAT was prescribed by only 52.8% of practitioners for TB diagnosis and drug resistance. Conclusion: The method of prescribing non-DOTS ATT prescription drugs was not as per NTEP guidelines, and CBNAAT prescription was also less.

339

Original Article

Sameer Arbat, Tejvir Singh, Tulika Arbat, Serafino Laura

Hybrid Technique of Radial Endobronchial Ultrasound Combined with Lung Cryobiopsy in the Diagnosis of Peripheral Pulmonary Lesions

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:4] [Pages No:42 - 45]

Keywords: Bronchoscopy, Endobronchial ultrasound, Pulmonology, Transbronchial lung biopsy, Transbronchial lung cryobiopsy

   DOI: 10.5005/jp-journals-11010-1013  |  Open Access |  How to cite  | 

Abstract

Introduction: The diagnosis of peripheral pulmonary lesions (PPLs) may be challenging as they are bronchoscopically invisible. Radial endobronchial ultrasound (EBUS) is useful for accessing PPL, with the help of transbronchial lung biopsy (TBLB) and cryoprobe. Although PPL can also be accessed with the help of transthoracic ultrasound or computerized tomography (CT)—guided fine-needle aspiration (FNA), there is a significant risk of pneumothorax. Patients and methods: This was a retrospective observational study. Patients with PPL on CT thorax were subjected to bronchoscopy. Radial EBUS (R-EBUS) via flexible bronchoscope with fluoroscope was used to determine the site and cryobiopsy was taken. Bleeding was controlled by an endobronchial balloon placed through a rigid bronchoscope as a conduit. Results: A total of 40 patients underwent R-EBUS with fluoroscopy-guided cryobiopsy. Histopathological diagnosis was achieved in 34 (85%) cases. Out of total 40 cases, 10 were diagnosed as adenocarcinoma, 9 as squamous cell carcinoma, and 4 as bronchitis and so on. No complication was seen in 12 cases, and 1 patient required hospitalization for observation. Conclusions: R-EBUS-guided cryobiopsy in the diagnosis of PPLs is a safe procedure with good diagnostic yield.

599

Original Article

Praful S Patil, Dhruba H Chandi, Ashok Rangaiahagari

Utility of GeneXpert MTB/RIF in the Rapid Diagnosis of Extra Pulmonary Tuberculosis

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:46 - 48]

Keywords: Extrapulmonary tuberculosis, GeneXpert MTB/RIF test, Real-time polymerase chain reaction

   DOI: 10.5005/jp-journals-11010-1003  |  Open Access |  How to cite  | 

Abstract

Introduction: The diagnosis of extrapulmonary tuberculosis (EPTB) is a challenge. World Health Organization (WHO) recommends the use of GeneXpert MTB/RIF assay [Cepheid, United States of America (USA)], using a heminested real-time polymerase chain reaction (PCR) to amplify a Mycobacterium tuberculosis-specific sequence of the rpoB gene for the rapid and simultaneous detection of M. tb complex (MTBC) and resistance to rifampicin from a clinical specimen. The purpose of this study is to evaluate the performance of the GeneXpert MTB/RIF test with conventional mycobacterial culture in EPTB specimens. Materials and methods: This prospective study (February–October 2017, 11 months) includes data on 287 EPTB specimens that were processed by conventional culture on Lowenstein–Jensen (LJ) medium and the rapid molecular-based GeneXpert MTB/RIF assay system. Results: Among the 287 EPTB samples tested, GeneXpert detected the deoxyribonucleic acid of MTBC in 51 samples (17.8%). Standard bacteriological assays, including acid-fast bacilli microscopy and culture, were positive in 26 (9.1%) and 35 (12.1%) specimens respectively. The performance of GeneXpert results was evaluated against culture as a gold standard. The overall sensitivity and specificity of the Xpert assay were calculated to be 94.6 and 94.4%, respectively. The sensitivity of the Xpert assay with tissue specimens was 84.6 and 80.7% specificity, while there was 86.6% sensitivity and 98.1% specificity with the body fluids. Conclusion: GeneXpert had high performance than culture for the EPTB specimen. It can be a useful tool for the early diagnosis of patients with high clinical suspicion of EPTB. The other major advantage of GeneXpert is that it simultaneously detects rifampicin resistance within 2 hours.

537

Original Article

Shimpi Chopra, Purabi Barman, Tarun Thukral

Epidemiological Profile of Mold Infections in Coronavirus Disease 2019 Patients

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:6] [Pages No:49 - 54]

Keywords: Comorbidities, Coronavirus disease 2019, Diabetes mellitus, Mucorales, Rhinosinusitis

   DOI: 10.5005/jp-journals-11010-1002  |  Open Access |  How to cite  | 

Abstract

Background: Coronavirus disease 2019 (COVID-19) has predisposed to secondary fungal infections, particularly when it is associated with varied comorbidities and immunocompromised situations. Materials and methods: We performed a retrospective clinico-epidemiological evaluation on 45 patients with a history of COVID-19 who presented with clinical features of fungal infections and their association with preexisting comorbid risk factors. The clinico-demographic information of the patients was obtained using a pro forma. Samples from representative clinical sites were collected, like respiratory secretions, pus, or tissue samples from nasal cavities and paranasal sinuses. These samples were processed as per the standard mycological procedures and the fungal isolates, so obtained, were identified according to their culture and microscopic characteristics. Results: The median time interval for the appearance of clinical features of fungal infections from the time of COVID-19 diagnosis was 17 days. Diabetes mellitus (DM) (84.44%) was found to be the leading comorbidity. History of administration of glucocorticoids was noted in 62.22% of the patients. The most frequent presentation was rhinosinusitis in 86.67% of the individuals. Different kinds of molds were isolated in 73.33% of the specimens, with Mucorales (78.89%) being the dominant one. The 32 admitted patients were managed by antifungal therapy and/or surgery. A total of nine patients did not respond to the treatment and succumbed to the disease. Conclusion: Though the true prevalence of these mold infections is not known, but timely diagnosis and management are extremely important in view of their high mortality.

270

Original Article

PV Harsha, Durga Balagopalan, MM Aneesh, Ponneduthamkuzhy Thomas James, Ajit Bhaskar, S Krishnaveni

Profile of COVID-19 Patients with Persistent Respiratory Symptoms

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:4] [Pages No:55 - 58]

Keywords: Computed tomography, COVID-19, Organizing pneumonia, Oxygen saturation

   DOI: 10.5005/jp-journals-11010-1010  |  Open Access |  How to cite  | 

Abstract

Background and objective: COVID pandemic struck the entire world causing high mortality and morbidity. After-effects of the infection were manifested in various clinical forms for the varying duration. As the pandemic waxes and wanes, COVID has become one of the differential diagnoses for various clinical and radiological pictures and triggers for respiratory diseases. While COVID sequelae are still much to explore, this study aimed to assess the clinicoradiological profile of COVID-19 patients who have persistent symptoms pertaining to the respiratory system. Materials and methods: This prospective study was conducted for 1 year from December 2020 to December 2021. COVID-19 patients aged between 10 and 85 years with persistent respiratory symptoms were included in this study. Results: There were a total of 90 patients. The mean age was 50.79 years. Forty-eight (53.3%) patients were males and 42 (46.7%) were females. Among these patients, eight patients (8.9%) had an asymptomatic or minimal symptomatic gap of at least 2 weeks from the date of positivity to the development of full-blown symptoms. The maximum duration of symptoms reported was more than 1 year and continuing. Dyspnea on exertion was the predominant symptom, in 59 patients (65.6%). Hypoxia at rest was seen in 35 (38.9%) patients, whereas seven patients with normal oxygen saturation showed exertional desaturation. Out of the 33 patients with post-COVID changes in computed tomography (CT) of the thorax, ground-glass opacities were seen in all 33 patients (100%), consolidation in 18 patients (54.5%), septal thickening in 18 patients (54.5%), and fibrosis in 15 patients (45.4%). Predominant CT finding was that of organizing pneumonia, but a few had fibrotic picture similar to usual interstitial pneumonia (UIP) or fibrotic nonspecific interstitial pneumonia (fibrotic NSIP). Hypoxia severity was significantly associated with diabetes (p = 0.028), hypertension (p = 0.028), chronic kidney disease (p = 0.027), chronic obstructive pulmonary disease (p = 0.001), obesity (p = 0.000), and smoking (p = 0.004). CT severity scoring was significantly associated with hypoxia severity. Conclusion: After the initial weeks, COVID patients can present with varying respiratory symptoms. They can present with respiratory failure as late as 1 month after the test positivity. Although CT picture was predominantly that of organizing pneumonia, COVID lung sequelae can masquerade as UIP or fibrotic NSIP as in idiopathic pulmonary fibrosis and connective tissue disease-associated interstitial lung disease, whereas atypical infections and malignancy can masquerade as COVID lung. Irreversible changes like honeycombing can occur as early as 2nd month after COVID.

367

Original Article

Sanjay Avashia, Salil Bhargava, Deepak Bansal, Ketan Jha

Efficacy of COVID-19 Vaccines against Mortality among COVID-19 Cases of Indore, Central India

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:59 - 61]

Keywords: Coronavirus disease 2019, Coronavirus disease 2019 mortality, Vaccine efficacy

   DOI: 10.5005/jp-journals-11010-1017  |  Open Access |  How to cite  | 

Abstract

Background: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-COV2) virus is being used since January 2021 in India. Current data shows that the vaccines are effective against coronavirus disease 2019 (COVID-19) related morbidity and mortality. Vaccine efficacy in fully vaccinated may decrease over time. Materials and methods: Retrospective study was done to assess vaccine efficacy against COVID-19 pneumonia related deaths in a tertiary COVID-19 care hospital in Central India. The vaccine efficacy was assessed in the patients with respect to age, gender, and comorbidity and since they received 2nd dose of the vaccine, the study also investigated the waning effectiveness over time leading to mortality. Results: Vaccine effectiveness against COVID-19 mortality did not peak in the early weeks post receiving the second dose (12.5% mortality in 1st month) but then it increased by the 5th month (7.4% mortality). After the 5th month, vaccine effectiveness decreased (11.9% mortality). Waning of vaccine effectiveness causing mortality was greater in the elderly ≥60 years (18.2%) than in patients <60 years (5.4%). Fully vaccinated males had higher mortality than females. A greater reduction in vaccine efficacy was observed in persons with comorbidities (14.1% mortality) than in noncomorbid (3.4% mortality). On comparing all patients with comorbidity, there was lower mortality in patients who received a full dose of vaccination (14.1%) than those who didn\'t (22.7%). Fully vaccinated elderly ≥60 years (18.2%) had lesser mortality than those who were not vaccinated (36.4%). Conclusion: Waning of vaccine effectiveness and related death is seen against COVID-19 after the 5th-month post second dose of the COVID-19 vaccine. Greater mortality is noted in the elderly, males, and patients with comorbidities. Fully vaccinated elderly and patients with comorbidities had a lower mortality rate than those who were not vaccinated.

360

Original Article

Hesameddin Modir, Behnam Mahmoodiyeh, Alireza Kamali, Farzad Z Barsari, Sulmaz Ranjbar

Efficacy of gargling with Licorice extract, Ketamine, and Magnesium Sulfate before Laryngoscopy: Tracheal Intubation in Prevention of Sore Throat, Hoarseness, and Cough; a Randomized Clinical Trial

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:5] [Pages No:62 - 66]

Keywords: Cough, Gargling, Hoarseness, Ketamine, Licorice extract, Lidocaine, Magnesium Sulfate, Sore throat, Tracheal intubation

   DOI: 10.5005/jp-journals-11010-1020  |  Open Access |  How to cite  | 

Abstract

Background and objective: Tracheal intubation is considered to represent a major cause of trauma to the airway mucosa, which can give rise to a postoperative sore throat. This randomized clinical quality improvement trial on the well-established benefit of gargling with licorice extract, ketamine, and magnesium sulfate before laryngoscopy and tracheal intubation was undertaken to address how to prevent throat soreness, hoarseness, and cough. Patients and methods: In a prospective, double-blind randomized controlled trials, 105 patients who were undergoing laryngoscopy and endotracheal intubation under general anesthesia were recruited. They were assigned into one of three intervention groups, including ketamine, licorice, and magnesium sulfate, using block randomization and requested to gargle twice for 15 seconds and 20 minutes before anesthesia induction and to spit out. Postoperative sore throat, cough, and hoarseness were recorded from endotracheal extubation at baseline (T0) every 10 minutes during recovery until T45 (45 minutes) and at initial 24-hour time points (2, 4, 8, 12, and 24 hours) later. Analysis of variance (ANOVA) and chi-squared tests was used for data analysis at a significance level of p = 0.05 in Statistical Package for the Social Sciences (SPSS) v20 (Chicago, Illinois, United States of America) software. Results: The mean age of patients was 48.21 ± 9.21 years, and 57.1% were male. No statistically significant intergroup difference was observed in the study groups for oxygen saturation (SpO2), heart rate, blood pressure, and duration of surgery. Our results showed that less sore throat was found in the ketamine group at T8/T12 (8 and 12 hours after recovery (p < 0.05). In addition, no statistically significant intergroup difference was revealed in cough and hoarseness during the times studied (p > 0.05). Conclusion: Our evidence confirmed that ketamine, licorice, and magnesium sulfate appeared to be able to effectively reduce pain, cough, and hoarseness and to be associated with similar hemodynamic changes, while the ketamine-treated subjects manifested a marked decrease in sore throat pain intensity with postoperative times of T8 and T12. Consequently, gargling with ketamine continues to demonstrably be put forward as a promising candidate to control postoperative sore throat but is as equal as other intervention drugs in terms of effectively controlling cough or hoarseness. Ultimately, the final choice relies on both patient acceptance and anesthesiologist preference.

552

Original Article

Aditi N Zawar, Raziya M Nagarwala, Rachana P Dabadghav

Effect of Walking Course Length on 6MWT: An Experimental Study

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:4] [Pages No:67 - 70]

Keywords: 6-minute walk test, Course length, Maximal oxygen uptake, Walking speed

   DOI: 10.5005/jp-journals-11010-1019  |  Open Access |  How to cite  | 

Abstract

Introduction: The 6-minute walk test (6MWT) is a validated tool of submaximal intensity used as an objective measure of functional exercise capacity. Changes in 6-minute walk distance (6MWD) are used to evaluate the efficacy of therapeutic interventions. American Thoracic Society (ATS) guidelines state that the walking course for the 6MWT must be 30 m. In a primary care physiotherapy setting, a 30 m straight course is often not available. Space limitations often force clinicians and researchers to conduct 6MWT on shorter courses. The purpose of this study was to determine the influence of 5, 10, 15, and 30 m course lengths on 6MWD and physiological parameters during the 6MWT. Materials and methods: A total of 80 healthy adults from 18 to 30 years performed four 6MWTs along 5, 10, 15, and 30 m course lengths in a corridor randomly, on consecutive days. The 6MWD and vital parameters on all four course lengths were recorded. Walking speed and maximal oxygen uptake (VO2 max) were calculated. Results: There was a significant difference in 6MWD, walking speed, and VO2 max over 5, 10, 15, and 30 m course lengths during 6MWT (p < 0.05). There was no significant difference observed in the change in heart rate (HR) between 6MWT on 5 and 10 m course lengths and 6MWT on 15 and 30 m course lengths (p > 0.05). Conclusion: The course length strongly influences the performance during the 6MWT and the results on 5, 10, 15, and 30 m courses are not interchangeable with each other. However, there was a similar submaximal cardiac performance on 15 and 30 m course lengths.

345

Original Article

Kusha Narayan Gherwara, Sandeep B Shinde

Estimation of Functional Exercise Capacity in Pulmonary Tuberculosis Survivors

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:6] [Pages No:71 - 76]

Keywords: Functional exercise capacity, 12-minute walk test, Oxygen saturation, Pulmonary tuberculosis, Respiratory rate, 15-step oximetry test

   DOI: 10.5005/jp-journals-11010-1024  |  Open Access |  How to cite  | 

Abstract

Background: Pulmonary tuberculosis (PTB) is the main apprehension universally. Although treatable, tuberculosis (TB) endures depressingly and disturbs patients’ health-related quality of life (HRQoL) and functioning even after treatment.1 Resources have revealed that multidrug treatments can lead to unwanted adversative drug reactions such as arthralgia, neurological disorders, hepatotoxicity, and allergic reactions. TB affects the respiratory system, that is, airflow patterns, functional exercise capacity, and ultimately the QoL of patients even after the completion of the 4-month rifapentine-moxifloxacin TB treatment regimen and 6- or 9-month rifapentine, isoniazid, pyrazinamide, and ethambutol (RIPE) TB treatment regimen. Throughout the treatment of active PBT, lung function damage is usually restrictive. Materials and methods: A total of 86 PTB survivors were selected for the PTB survivors’ group, who had a history of taking complete treatment for PTB. Each survivor was evaluated for functional exercise capacity with a 12-minute walk test (MWT), 15-step oximetry test, and HRQoL questionnaire. Results: Pulmonary tuberculosis (PTB) causes variation in vitals and also has negative effects on physical functioning. The study results demonstrated that out of 86 total respondents, the majority (97–100%) had better oxygen levels pretest (12-MWT and pulse oximetry) with an average of 17–20 bpm. 47% of individuals were underweight, with posttest oxygen saturation reduced to 91–93% and respiratory rate increased to 26–30 bpm. QoL was also compromised. Conclusion: This present study concluded that PTBs and their treatment do affect the functional exercise capacity of the survivors. The respiratory rate and blood pressure are markedly increased, whereas the oxygen saturation and manual muscle strength are markedly reduced. PTB survivors also suffered from compromised health and QoL, that is, emotional and mental weaknesses.

500

Original Article

Skakun Oleksiy Zenoviiovych

Predictors of Severe and Critical COVID-19 in Hospitalized Hypertensive Patients

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:6] [Pages No:77 - 82]

Keywords: Coronavirus disease 2019, Hospitalized, Hypertension, Predictors, Risk factors

   DOI: 10.5005/jp-journals-11010-1014  |  Open Access |  How to cite  | 

Abstract

Introduction: The severe condition develops in every fifth patient with coronavirus disease 2019 (COVID-19). This study is aimed to assess the factors predicting severe and critical conditions in hypertensive patients with COVID-19-associated pneumonia. Materials and methods: A total of 106 unvaccinated hypertensive patients hospitalized for COVID-19-associated pneumonia were enrolled in the study. Results: Median body mass index (BMI) was higher in patients with severe/critical condition [30.4 (26.4–34.1) kg/m2] than in patients with moderate condition [25.3 (23.5–29.1) kg/m2] (p < 0.001). Diabetes mellitus was more prevalent in patients with severe/critical condition (40.7 vs 21.3%, p = 0.04). Erythrocyte sedimentation rate (ESR) was higher in patients with severe/critical condition [28.0 (14.0–34.5) vs 37.5 (24.0–46.5) mm/hour] (0.004). Patients who developed severe/critical condition were scored higher according to the community-acquired pneumonia symptom (CAP-Sym) questionnaire [30.0 (20.0–37.0) points] than patients who developed the moderate condition [22.0 (16.0–33.0) points] (p = 0.03). Also, ferritin level was higher in patients who developed severe/critical condition [430.5 (177.0–733.0) ng/mL] than in patients who developed the moderate condition [315.5 (169.0–396.0) ng/mL] (p = 0.03). BMI of ≥30 kg/m2 increased the odds of severe/critical condition development [odds ratio (OR) = 3.83 (1.61–9.09), p = 0.002] and was the only independent predictor for the severe/critical condition according to the multivariate logistic regression analysis. Conclusion: Increased BMI, diabetes mellitus, high ESR, and ferritin level at admission predict severe/critical disease in unvaccinated hypertensive patients hospitalized for COVID-19. However, only BMI of ≥30 kg/m2 is an independent risk factor for severe/critical disease according to multivariate logistic regression analysis. CAP-Sym questionnaire may be used for the prediction of severe/critical COVID-19.

310

REVIEW ARTICLE

Gokul G Krishna, Ann Mary Jose, Minimole Vijayan, Amal Alsomali, Abdullah S Alqahtani, Edan M Alzahrani, Rajesh Shenoy, Sabu Karakka Mandapam, KP Gireesh Kumar

Evidence-based Practice and Quality Improvement in Allied Healthcare Education

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:7] [Pages No:83 - 89]

Keywords: Allied healthcare, Education, Evidence-based practice, Quality improvement

   DOI: 10.5005/jp-journals-11010-1025  |  Open Access |  How to cite  | 

Abstract

Evidence-based practice (EBP) is acknowledged as a fundamental component of training for healthcare professionals, including respiratory therapists and other allied healthcare professionals. Understanding the key similarities, advantages and differences between it and quality improvement (QI) can help to advance allied healthcare education (AHE) and clinical practice. However, the differences between ”best EBP” and actual clinical care show how difficult it is to become competent in this field. Professional education to support EBP continues to be a significant and pressing concern. The importance of QI in medical education is becoming more widely recognized, which is also equipping allied health professionals with the knowledge and abilities to improve patient experiences and outcomes, population health, and monitoring and managing per capita healthcare costs. All frontline healthcare providers, including AHPs and RTs, should possess the fundamental capability to implement EBP and QI. Integrating EBP and QI into AHE improves the ability of AHPs to engage in safe clinical practice, which in turn increases the quality of patient care.

928

CASE REPORT

Youssef Motiaa, Siham Alaoui Rachidi, Smael Labib, Hicham Sbai

SARS-COV2 Pneumonia Revealed by Extensive Subcutaneous Emphysema

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:90 - 92]

Keywords: COVID-19, Pneumomediastinum, Pneumothorax, Subcutaneous emphysema

   DOI: 10.5005/jp-journals-11010-1008  |  Open Access |  How to cite  | 

Abstract

Spontaneous subcutaneous emphysema (SCE), pneumomediastinum, and pneumothorax in nonventilated COVID-19 patients are being increasingly recognized as complications of COVID-19 pneumonia. We report a case of a young man with no predisposing risk factors for pneumothorax who was diagnosed with a severe acute respiratory syndrome-COV2 pneumonitis revealed by extensive SCE with fatal outcome. Computed tomography of the thorax, abdomen, and pelvis revealed a diffuse lung injury, a pneumothorax, and pneumomediastinum. These complications of COVID-19 pneumonia may be associated with poor prognosis.

323

CASE REPORT

Harveen Kaur, J Arora, NC Kajal, Dilbag Singh

A Rare Case of Cryptogenic Organizing Pneumonia with Sarcoidosis Overlap

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:93 - 95]

Keywords: Bronchoalveolar lavage, Cryptogenic organizing pneumonia, High-resolution computed tomography chest, Sarcoidosis, Serum angiotensin-converting enzyme levels, Transbronchial biopsy

   DOI: 10.5005/jp-journals-11010-1012  |  Open Access |  How to cite  | 

Abstract

Cryptogenic organizing pneumonia (COP) with sarcoidosis, as an overlap disease, occurs infrequently. We report a case of an elderly female, who was diagnosed as a case of COP based on radiological and histopathological evaluation. After the systemic steroid therapy, there occurred a significant fall in serum angiotensin-converting enzyme (SACE) levels, pointing toward the clinical diagnosis of sarcoidosis. This case raises the possibility of sarcoidosis as an etiology of COP in patients with a mixed spectrum of presentation.

372

CASE REPORT

Chhaya V Verma, Madhura R Patil, Niteen D Karnik, Mohan A Joshi

Video Call-based Strategically Planned Physiotherapy Management of Middle-aged Male Adult with Postacute Sequelae of COVID-19: A Case Report

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:4] [Pages No:96 - 99]

Keywords: Activity of daily living, Coronavirus disease 2019, Diabetic ketoacidosis, Video call-based physiotherapy

   DOI: 10.5005/jp-journals-11010-1021  |  Open Access |  How to cite  | 

Abstract

Introduction: Video call-based physiotherapy management has been recommended in the Coronavirus disease 2019 (COVID-19) pandemic to limit the spread of infection between patients and physiotherapist. Case description: We present a 55-year-old diabetic male who needed invasive ventilation for 2 weeks after being diagnosed with COVID-19 with severe acute respiratory distress syndrome (ARDS), COVID-19-induced diabetic ketoacidosis, and metabolic encephalopathy. At discharge on day 28, he had breathlessness in activity of daily living (ADL), fatigue, swelling with tingling in both lower limbs (LL), difficulty in getting up from a chair, and maintaining balance. Rehabilitation was started 2 days after discharge for 9 weeks and included counseling, breathing exercises, and exercises to improve strength, balance, and mobility. Results: The perception of fatigue and functional independence improved by 40 and 57%, and the 6-minute walk distance (6MWT) and 1-minute sit to stand (1 MSTS) improved by 61 and 90%, respectively. Conclusion: The structured implementation of physiotherapy management made the patient fully functional in his work by 5 months post-discharge.

244

CASE REPORT

Padmapriya Balakrishnan, Thirunavukkarasu Arun Babu

Ewing Sarcoma of Chest Wall (Askin's Tumor) in a 3-year-old Child: A Case Report

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:100 - 102]

Keywords: Askin's tumor, Child, Ewing sarcoma, Malignancy

   DOI: 10.5005/jp-journals-11010-1022  |  Open Access |  How to cite  | 

Abstract

Fever and difficulty in breathing in a child are common symptoms encountered in routine practice. Often, the underlying cause will be infectious etiology due to bacterial, viral, or tuberculous. However, a malignancy of the paraspinal soft tissue region mimicking infectious disease clinically in a child is challenging to diagnose and treat. Here, we report the Askin's tumor of the chest wall diagnosed in a child presented with fever, worsening dyspnea, and unilateral lung whiteout on a chest radiograph to insist on the importance of extensive and earlier evaluation even for common clinical symptoms.

449

CASE REPORT

MK Kanmani, Vinod Pal, Unnati Desai, Sharad Sable, Aravind Raj, Saby Anna

Sleep Disordered Breathing Postcoronary Artery Bypass Graft Surgery: A Case Report

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:103 - 105]

Keywords: Desaturation, Diaphragmatic palsy, Orthopnea, Sleep-disordered breathing, Sniff test

   DOI: 10.5005/jp-journals-11010-1023  |  Open Access |  How to cite  | 

Abstract

Unilateral diaphragmatic paralysis (UDP) is usually found incidentally in those who underwent chest radiography for some other reason. Often patients are asymptomatic at rest but may have breathlessness upon exertion and have a decrease in exercise capacity. Dyspnea at rest may occur if the patient has an underlying lung disease. Few develop orthopnea, which is less intense than patients with bilateral diaphragmatic paralysis (DP). Others present with positional snoring and progressive orthopnea misinterpreted it as sleep-disordered breathing. Here we present a 54-year-old male who presented late with sleep-disordered breathing and was diagnosed to have diaphragmatic palsy postcoronary artery bypass graft.

354

LETTER TO THE EDITOR

Closed Pleural Biopsy is Effective and Safe but Needs Addition of Ultrasound Thorax

[Year:2023] [Month:January-March] [Volume:12] [Number:1] [Pages:1] [Pages No:106 - 106]

   DOI: 10.5005/jp-journals-11010-1005  |  Open Access |  How to cite  | 

Abstract

 

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