Precision medicine also known as “personalized medicine” is a healthcare delivery system based on identifying biomarkers using genomics to link endotypes with phenotypes. Significant overlap exists between different phenotypes. Endotyping helps in giving a more precise definition of the phenotypes. However, it has proved to be most helpful in the development of therapeutics in oncology. Precision medicine has been brought to much more common use with COVID-19 with various drugs developed targeting interleukins. Precision medicine is now being actively developed for the management of infectious diseases and chronic and lifestyle diseases. Various challenges still exist in the path of future development of precision medicine such as cost, ethics, incorporation of machine learning, and availability of trained manpower to manage the data and algorithms. In this review, we will discuss the growth and challenges precision medicine faces in the field of respiratory care.

Background: Pleural effusion (PE) represents a prevalent issue clinically for different diseases, such as tuberculosis (TB), pneumonia, malignancy, and heart failure (HF). So, we need specific investigations, such as measuring the level of lactic acid, for the rapid diagnosis of exudative PE causes. Objective: To assess pleural fluid (PF) lactic acid level in exudative PEs and to detect its role as a diagnostic test with the determination of a cutoff level of PF lactic acid to distinguish between the different causes of exudative PEs, such as tuberculous, parapneumonic, and malignant. Methods: Initial diagnostic thoracentesis was performed in all cases. The PF lactic acid level was assessed by a calibrated blood gas analyzer. Results: We studied 80 patients. A total of 32 patients had parapneumonic pleural effusion (PPE) (15 simple and 17 complicated), 19 had tuberculous pleural effusion (TPE), and 29 had malignant pleural effusion (MPE). PF lactic acid median level was significantly more regarding the complicated PPE (CPPE) [mean 7.19 mmol/L with range (2.7:11.6)] in comparison to other groups. The area under the curve (AUC) scored 0.912 [p < 0.0001, 95% confidence interval (CI) (0.757:0.983)]. PF lactic acid cutoff level of >3.4 mmol/L was significant in predicting CPPE with high specificity and positive predictive value scored, with low sensitivity and negative predictive value (100, 100, 82.4, and 83.3%, respectively). Also, PF lactic acid could be used to discriminate between TPE and MPE. The AUC scored 0.735 [p < 0.001, 95% CI (0.588:0.852)], and the PF lactic acid optimal cutoff level was ≤2.8 mmol/L resulting in 79.3% sensitivity, 68.4% specificity, 68.4% negative predictive value, and as well as 79.3% positive predictive value regarding the prediction of MPE. Conclusion: Pleural fluid (PF) lactic acid level measurement has a high accuracy for the diagnosis and discrimination between the different causes of exudative PE.

Background and objectives: No information is available from India on the kinetics of biochemical and inflammatory markers on the outcomes of invasively ventilated coronavirus disease 2019 (COVID-19) patients. Patients and methods: In a retrospective study on invasively ventilated COVID-19 patients we performed a time-course design to look at the development of organ dysfunction and its association with survival. Results: A total of 156 patients were studied. Higher acute physiology and chronic health evaluation (APACHE) II scores on day 1 and Sequential Organ Failure Assessment (SOFA)/Simplified Acute Physiology Score (SAPS) II scores were noted in nonsurvivors. Nonsurvivors had significantly higher blood urea nitrogen, neutrophil-lymphocyte ratio, serum ferritin, interleukin (IL)—6, and D dimer levels as compared to survivors (p < 0.05) as a baseline. A higher percentage of nonsurvivors had serum sodium, serum chloride, blood urea nitrogen (BUN), and serum creatinine levels both above and below limits as compared to survivors. A significantly higher percentage of nonsurvivors had higher arterial pressure of carbon dioxide (PaCO₂), lower platelet and absolute lymphocyte counts, and multiorgan dysfunction syndrome (MODS) as compared to survivors (p < 0.05). Positive fluid balance was associated with higher mortality. Conclusion: Variables recorded at baseline and their dynamics during the period of invasive ventilation were correlated with survival.

Background: Pulmonary function impairment among diabetic patients has rarely been studied. Hence, the present study was undertaken to analyze the impact of diabetes and glycemic control on pulmonary function tests (PFT). Materials and methods: A total of 120 patients were included in a cross-sectional study conducted at a tertiary care center in India. Formerly diagnosed diabetic patients with alteration in blood sugar levels were included. According to the duration of diabetes, there were three groups. Among all the patients, PFT was performed and correlated with the duration of the diabetic condition and glycated hemoglobin (HbA1c). Results: Significant decrease was observed in the mean value of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and peak expiratory flow rate (PEFR) in relation to their predicted values with preserved FEV₁/FVC ratio, which is indicative of a restrictive pattern of ventilatory dysfunction. A significant negative correlation was found between the duration of diabetes, glycemic control, and PFT impairment. Conclusion: Long-term diabetes worsens pulmonary function impairment and poor glycemic control. Hence early screening of the respiratory system and strict glycemic control may help to prevent the progression of pulmonary dysfunctions among individuals with diabetes mellitus (DM).

Context: With the growing incidence of cases in the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), there have been a number of spikes in the cases over the last 3 years and India has witnessed three waves of different strains of SARS-CoV2. Aims: The aim of this study was to evaluate the patient demographics, the population at risk, signs and symptoms presented, the effect of comorbidities, and treatment outcomes. Settings and design: Retrospective noninterventional observational study. Materials and methods: From January 2020 to February 2022, a study was carried out at Kalpana Chawla Government Medical College, Karnal, Haryana. The study included all inpatients above the age of 18 years who tested positive for COVID-19 through either a rapid antigen test (RAT) or reverse transcription-polymerase chain reaction (RT-PCR) from nasopharyngeal or oropharyngeal swabs. The sample size of the study was 300. Results: In all three waves, the incidence of COVID-19 was more common among men. The average age of patients was 39.8, 49, and 50 years in waves one, two, and three, respectively. Among various comorbidities, diabetes was the most prevalent, with 25, 33, and 29% of patients affected in waves one, two, and three, respectively. In the first wave, all patients received antiviral therapy, while in the second and third waves, 70 and 10% of patients were treated with antivirals, respectively. During the third wave, 60% of patients had received two doses of vaccine and 16% had received a single dose. Conclusion: The study provides insights into the patient characteristics, management, and treatment of COVID-19 patients in three different waves. Clinical significance: The study gives a bird's eye view of the treatment across the three waves and the evolution of management strategies. Also, the effectiveness of vaccination was seen in the third wave.

Background: The coronavirus disease 2019 (COVID-19) infection is considered the most detrimental among patients with comorbid conditions during the prevaccination era. Drugs have been repurposed for the management of COVID-19 infection. An attempt was made to study the morbidity and mortality outcome and the role of anti-TB drug therapy in COVID-19 disease prognosis, in patients of tuberculosis (TB) on anti-TB drug therapy acquiring COVID-19 infection. Materials and methods: For this study patients diagnosed with COVID-19 infection with TB were divided into three groups. Group I—patients with TB and COVID-19 infection, Group II—patients on anti-TB therapy who acquired COVID-19 infection and Group III—patients suspected with coronavirus disease 2019 (COVID-19) infection, found to be COVID-19 negative and diagnosed with TB from March 2019 to June 2021. All were studied for the duration of hospital stay, clinical symptoms, and associated comorbidity. Kruskal–Wallis and Chi-squared tests were applied. Result: From records of the designated microscopic center (DMC) of Government Medical College, Surat, a total of 888 patients were diagnosed with TB during the study period, 46 of whom reported to the COVID-19 care center with clinical suspicion. Out of 46 patients, 52.2% had TB, 23.9% had diabetes, 15.2% had hypertension, 4.3% had chronic kidney disease (CKD) with DM & HT, 2.1% had rheumatoid arthritis (RA). Out of a total of 46 patients, 41 recovered, while five died. The median duration of disease among patients from all groups was 15 days. There was a significant association between TB patients on AKT with COVID-19 test results. Those patients who were on AKT had lesser chances of getting an infection with COVID-19 (χ² = 272.41, p < 0.00001). Conclusion: The study observation leads toward anti-TB drugs having a protective role against COVID-19 infection.

Aims and background: Carcinoma of lung features is one of the most frequently encountered malignancies in the world, which accounts for most cancer deaths. To buckle down this deadly disease, novel tools for early diagnosis need to be explored. Biomarkers, being a simple and noninvasive method, are being researched all over the world for their role in screening, early detection, and confirmation of the diagnosis of specific types of cancer, as well as to predict the prognosis, monitor response to treatment, and detect recurrence. Materials and methods: The current study evaluated the values of neuron-specific enolase (NSE), cytokeratin fragment 19 (CYFRA 21-1), carcinoembryonic antigen-related cell adhesion molecule (CEACAM), C-reactive protein (CRP), and lactate dehydrogenase (LDH) were evaluated in 75 participants, 25 each of lung cancer, benign disease, and healthy controls respectively, both individually as well as together as a panel in various combinations of set of two/three/four/five biomarkers for diagnosis, accuracy, sensitivity, and specificity of all the different combinations was calculated. Results: Mean serum levels of all these biomarkers were elevated in patients with lung cancer vs normal healthy controls. It was inferred that the best panel was a combination of two biomarkers, CRP and NSE, together, which yielded a specificity of 94%, accuracy of 82.67%, and sensitivity of 60% (p-value of <0.001). Conclusion: Biomarkers, both individually and as a combination as a panel may serve as useful tools for early detection of this deadly disease.

Introduction: The health, economic, social, and educational systems worldwide have been seriously impacted by the coronavirus disease of 2019 (COVID-19). Students’ academic results and mental health were greatly impacted by the lack of traditional face-to-face lectures, access to digital learning, and possibilities for networking and socializing. The study's outcome was to investigate the stress, depression, and anxiety experienced by undergraduate health science students during and after the COVID-19 lockdown. Materials and methods: We collected data from 470 students using three validated questionnaires: the Kessler Psychological Distress Scale (K10) for stress, the Generalized Anxiety Disorder (GAD-7) for anxiety, and the Patient Health Questionnaire (PHQ-9) for depression. The questionnaires were sent to potential participants via e-mail during the COVID-19 lockdown. After the lockdown, a follow-up was made. Results: A total of 368 (78.3%) participants completed the questionnaires; 30.7% (n = 113) vs 19.8% (n = 73) experienced severe stress during and after the lockdown, respectively. The mean scores for stress, anxiety, and depression during the lockdown vs postlockdown were 22 (11) vs 20 (11), 9 (7) vs 9 (6), and 7 (6) vs 7 (6.5), respectively. Conclusion: During the COVID-19 lockdown, undergraduate health science students experienced serious mental health issues, especially those under medication for psychological disorders. A significant improvement was observed postlockdown in overall mental health among students, but the number of students experiencing mental health issues remained high.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by the impact of bad air, often progressive and irreversible, caused by a combination of different lung diseases, damage to the lungs, and emphysema, followed by inhalation of bad air and gases, especially smoke, causes, and often affects lung disease with many differences. By adding lactoferrin along with N-acetylcysteine (NAC), it targets nuclear factor-κB (NF-κB), which is responsible for inflammatory responses. This combination of NAC 600 + lactoferrin 50 mg offers synergistic effects and reduces mucus hypersecretion (as a mucolytic agent). Objective: This study was a randomized, open-label, actively controlled, prospective, single-center, two-arm, parallel to assess the efficacy, safety, and tolerability of the combination of NAC 600 + lactoferrin 50 mg against NAC 600 mg in the symptomatic treatment of patients suffering from productive cough associated with acute bronchitis. Materials and methods: The study was conducted under a qualified investigator at a single center in India. To assess the primary efficacy of the investigational products, assessment through a modified cough and sputum relief questionnaire was evaluated at baseline days 0, 3, 5, and 8. Secondary efficacy was evaluated through a 7-point Likert scale, bronchial severity score (BSS), and global clinical impression of improvement or change (CGIC); secondary safety endpoints were measured through adverse events (AEs) or serious AEs (SAEs) collected during the study. Results: It was observed that the combination of NAC and lactoferrin showed better primary and secondary efficacy results with respect to the treatment of acute bronchitis. The rate of reduction in the severity of acute bronchitis and improvement of breathing condition/general well-being is also showing better results in combination products compared to NAC 600 mg. SAEs were not reported during the conduct of the study. Conclusion: Based on the study results/data, it can be concluded that the combination of NAC and Lactoferrin shows better efficacy results with no linked AEs with respect to the treatment of acute bronchitis compared to single treatment. However, long-term studies will be done to evaluate the long-term effectiveness of the combination of NAC and lactoferrin.

Aim and background: The present study on paraquat poisoning gives a detail about the compound, presentation of patient to emergency, management and complications. Paraquat is a bipyridylium compound that, when ingested, has a corrosive action locally and organ injury caused by free radicals. Pneumothorax and pneumomediastinum cause respiratory distress, eventually increasing the mortality. Case description: Herein we report two young males who presented with history of consumption of paraquat. Gastric lavage was done at a local hospital for both patients and presented to us in a hemodynamically stable state for further management. Both the patients underwent ICD insertion and were treated with steroids, cyclophosphamide and antioxidants and one of patient requiring mechanical ventilator support. In spite of aggressive treatment both the patients have succumbed. Conclusion: In case of history of exposure or ingestion of paraquat early presentation may help in aggressive decontamination reducing further complications. Whereas patients presenting with pneumomediastinum pose a 100% risk of mortality.

Introduction: Among the varied complications of tracheostomy, a displaced tube is a dreaded one, especially with an immature tract. Case description: We present a young lady at 3 weeks post emergency tracheostomy, done at another hospital, presumably for Ludwig's angina. With no medical details available, the soiled outer Jackson's tracheostomy tube required change. Her financial constraints, supplemented with the resource shortfalls, contributed to Fuller's tube. Furthermore, when dislodgement into a false tract was suspected, there were delays and dilemmas in reaching out to the least possible appropriate investigations, given her financial inadequacy. Conclusion: In resource-constrained hospitals, limited choice of tracheostomy tubes available for emergencies, the financial shortfalls of the patient limiting further assessment in clinical care, and the insufficient supervision of the presumably proficient residents may be few deficiencies to be defined to dodge any preventable complications.

Introduction: Poisoning with various synthetic chemicals used in farming is a public health problem of considerable importance worldwide, particularly in developing countries. One of them is paraquat (PQ), which is an extensively used synthetic, nonselective, contact herbicide in the Indian agriculture industry. Although fatalities due to accidental or suicidal oral ingestion of PQ are common, inhalational injury due to this poison is very rare and often difficult to diagnose without a proper specific history, since the presenting symptoms are usually nonspecific. Case presentation and progress: Here, we report a case of a 35-year-old male, who had an accidental inhalation of Paraquat that led to lung injury and further complications. Initially, the patient had mild flu-like respiratory symptoms, but later symptoms worsened and he progressed into pulmonary fibrosis within a span of 2–3 weeks. Treatment and outcome: The patient was admitted and managed in respiratory intensive care unit (ICU). He was managed with steroids, prophylactic antibiotic therapy, and other supportive measures. During the treatment course, he developed bilateral secondary spontaneous pneumothorax. Initially, he responded to the steroid pulse therapy, but later the pulmonary fibrosis progressed further and the patient succumbed after 1 month of ICU admission. Discussion and conclusion: Paraquat is a bipyridylium quaternary ammonium compound that will cause direct harm to the cellular structures by the production of various reactive oxygen species (ROS) and other free radicals. The lungs and kidneys are the most affected organs. The treatment of PQ intoxication is not well set out. Prompt supportive medical treatment is essential to minimize the damage and improve the chances of recovery.

Nocardiosis is an opportunistic infection that most commonly affects the lungs. On imaging, pulmonary nocardiosis can mimic tuberculosis, chronic pneumonia, and even malignancies. Mediastinal lymphadenopathy is relatively rare and esophageal involvement is even rarer in nocardiosis. However, it is possible for dissemination to occur to any site in the systemic form of the disease. Here, we present a case of biopsy-proven nocardiosis with esophageal and mediastinal nodal involvement with emphasis on imaging.

Introduction: Extraintestinal manifestations, including pulmonary manifestations like organizing pneumonia (OP), may be the presenting complaints in inflammatory bowel disease (IBD). In this case study, we discuss a case of OP in Crohn's disease to understand the pulmonary manifestation of IBD and its management. Case description: A 33-year-old female came with complaints of cough with minimal expectoration, headache, vomiting for 4 days, and dyspnea on exertion for 1 day. The patient has been a known case of Crohn's disease for the past 5 years. The patient had no history of smoking. High-resolution computed tomography (HRCT) thorax done on admission showed ground glass opacities and peribronchovascular interstitial thickening in the left lung, predominantly the left lower lobe. Transbronchial lung biopsy (TBLB) was done, and histopathology was suggestive of OP. The patient improved clinically and radiologically with steroids. Conclusion: Pulmonary manifestations of IBD are reported in numerous case studies. A patient with Crohn's disease presenting with respiratory symptoms should be carefully evaluated for infective etiology since patients are on immunosuppressants. Drug-induced lung disease is the most frequent pulmonary complication of IBD. OP is a rare manifestation of Crohn's disease, which requires careful evaluation, including bronchoscopy and biopsy, for diagnosis and management.

Poland syndrome (PS) is a rare congenital anomaly identified by the unilateral underdevelopment or absence of both the pectoralis major and minor muscles. We present a case of a 17-year-old male with right-sided chest flattening and shortness of breath for 3 years. Physical examination revealed reduced breath sounds on the affected side and chest X-ray showed right-sided hyperlucency. A noncontrast computed tomography (CT) thorax revealed absent pectoralis major and minor muscles on the right side, with visualized ribs appearing unremarkable, leading to a diagnosis of PS. Accurate diagnosis of PS requires imaging modalities such as chest X-rays, CT, and magnetic resonance imaging (MRI) scans. Treatment options for PS include reconstructive surgical procedures. PS affects chest development, leading to respiratory issues affecting an individual's quality of life.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belonging to the genus Betacoronavirus. Nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) of viral nucleic acid is considered the reference standard test for the diagnosis of COVID-19, however, in patients with false-negative RT-PCR results, high-resolution computed tomography (HRCT) scan of thorax plays an important role in diagnosing COVID-19 pneumonia. We have recently identified an atypical radiological finding on the HRCT scan of a patient with COVID-19 which we believe has not been described before in published literature. We have aptly named this radiological sign an “Owl's eye sign.”