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

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

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

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

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

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

Cavitating pulmonary tuberculosis (PTB) frequently occurs in adults and is uncommon in children. We report a case of a 3-year-old female child who presented with complaints of fever, cough, and poor weight gain. Clinical findings and chest X-ray were suggestive of right lower lobe pneumonia. The patient was treated with IV antibiotics, responded well, and was discharged. She presented with a recurrence of fever and weight loss. High-resolution computerized tomography of the thorax revealed cavitation in the posterior-basal segment of the right lower lobe of the lung. She was treated with antitubercular therapy (ATT) and responded well to the treatment.

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

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

Managing drug-resistant tuberculosis (MDR-TB) in patients with underlying coagulation disorders such as hemophilia and combined factor V and VIII deficiency presents significant challenges due to the risk of bleeding and potential drug-related complications. This case series details two unique instances of MDR-TB in such patients, exploring the complexities of treatment. Tuberculosis, known to induce a hypercoagulable state, can further complicate existing coagulation abnormalities. Using individualized shorter all-oral MDR-TB regimens alongside careful monitoring, both patients were successfully treated without severe bleeding episodes or deterioration in their coagulation profiles. This series highlights the importance of therapeutic approaches with close interdisciplinary collaboration to manage such cases effectively and improve patient outcomes.

Tuberculosis (TB) continues to be regarded as one of the leading diseases of infectious origin, accounting for the maximum number of deaths. Even though, owing to consistent and concerted efforts, we have made progress in terms of saving the lives of affected individuals and ensuring access to treatment, we are still off track in meeting our targets to end the disease epidemic by the year 2030. To interrupt the present trajectory of TB, there is an immense need to ensure access to disease-related prevention and care services, promote research and development, and introduce innovations. In the proposed initiative, five specific strategies—namely Engage, Accelerate, Align, Account, and Advocacy—have been proposed. In conclusion, in the battle against one of the deadliest infectious diseases, it is extremely crucial that no one must be left behind in equitably accessing prevention and care-related services. The proposed initiative is an attempt to intensify the ongoing efforts and thereby ensure that we take appropriate measures to be on the right track to attain the set targets by 2030.