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Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. The coexistence of COPD and obstructive sleep apnea (OSA) (i.e., overlap syndrome) has been reported in several studies. Both disorders independently increase the risk of cardiovascular complications. Hence, there is a theoretical possibility that cardiovascular parameters may be worse in patients with overlap syndrome compared to those with only COPD. However, this has been sparsely assessed in the literature. This study aimed to compare the clinical characteristics, echocardiography, and sleep parameters amongst COPD patients with and without sleep-related breathing disorders (SRBD). This observational, cross-sectional study included 30 patients with stable COPD. All participants underwent a detailed clinical evaluation, followed by level 1 polysomnography (PSG). Each participant underwent echocardiographic evaluation to estimate mean pulmonary artery pressure from right ventricular systolic pressure (RVSP). Based on their PSG findings, participants were classified into non-SRBD and SRBD groups. Both groups were further compared with respect to clinical characteristics, echocardiographic, and PSG parameters. We found that most of the participants (93.3%) were male, and the mean age of the study population was 56±8.2 years. The only SRBD identified in this study was OSA, which was observed in 80% of participants. In this group, OSA was not associated with obesity. Systemic hypertension (50%) was the most common comorbidity, followed by diabetes mellitus (26.67%), but both were not significantly different between the groups. The mean RVSP was significantly higher amongst OSA patients than non-OSA patients (41.25±14.98 versus 30.83±5.84, respectively; p=0.01). OSA was seen in 80% of participants with stable COPD, even in the absence of obesity. The presence of OSA was associated with a higher RVSP in this patient group.

In this study, the dissipation kinetics and health risk assessment of different insecticides in tomato under open field and poly-house conditions were investigated. A total of four insecticides, namely Chlorantraniprole 18.5 SC @ 30 g a.i ha−1, Flubendiamide 20% WG @ 48.0 g a.i ha−1, Indoxacarb 14.5 SC @ 60.0 g a.i ha−1, and Thiamethoxam 25% WG @ 50.0 g a.i ha−1, were applied on tomato at the 50% flowering stage, followed by 10 days after the first spray. Prior to actual sample analysis, QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) based extraction methodology for the chlorantraniliprole, flubendiamide, indoxacarb and thiamethoxam in tomato were verified and quantified on ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) in terms of linearity, sensitivity (detection limits), accuracy (% recovery) and precision (% RSD). The DT50 value of chlorantraniliprole, flubendiamide, indoxacarb and thiamethoxam in tomato under open field condition was 1.95, 2.25, 2.37 and 3.98, respectively and under poly house condition it was 3.05, 5.02, 2.68 and 4.82, respectively. Similarly, the safe waiting period of chlorantraniliprole, flubendiamide, indoxacarb and thiamethoxam in tomato under open field condition was 1.05, 0.83, 2.96 and 3.23, respectively and under poly house condition it was 2.02, 4.93, 4.09 and 7.33, respectively. Further, health risk assessment was evaluated and observed no risk for Indian consumers due to application of studied insecticides (RQ

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute respiratory disease that can lead to respiratory failure and death. Although anticipated that patients with chronic respiratory diseases would be at increased risk of SARS-CoV-2 infection and more severe presentations of COVID-19, it is striking that these diseases appear to be underrepresented in the comorbidities reported for patients with COVID-19. The first wave of COVID-19 has taught us important lessons concerning the enormous burden on the hospitals, shortage of beds, cross infections and transmissions, which we coped together. However, with the subsequent waves of COVID-19 or any other viral pandemic, to ensure that patients with respiratory illnesses receive adequate management for their diseases while minimizing their hospital visits for their own safety. Hence, we prepared an evidence-based summary to manage outpatients and inpatients suspected or diagnosed with COPD, asthma and ILD based on the experience of the first wave of COVID-19 and recommendations by expert societies and organizations.

BackgroundSleep is important for maintaining the metabolic processes in the body, and hence, disruption in sleep leads to metabolic derangement and accelerated atherosclerosis. The effect of sleep duration on subclinical atherosclerosis has been examined in several studies; however, data regarding sleep quality is lacking. The study aimed to assess the association between sleep quality and carotid intima-media thickness among healthy young doctors.Materials and MethodsThis was an observational cross-sectional study among 110 healthy young resident doctors. Anthropometric data were recorded and morning fasting venous blood samples were collected to assess fasting blood sugar, lipid profile and glycosylated haemoglobin (HbA1c). Pittsburgh Sleep Quality Index and Berlin questionnaire assessed subjective sleep quality and risk for obstructive sleep apnea, respectively. Carotid ultrasonography was done to detect the intima-media thickness.ResultsAverage age of the participants was 26.45 (±1.43) years, and 51.8% were male. Self-reported poor sleep quality was found in 54.5%. Carotid intima-media thickness (CIMT) was increased among 44.5% of participants. In the multivariate analysis, only poor sleep quality appeared to be associated with higher CIMT (P 30 min), sleep efficiency (

Observation of episodes of sleepwalking and prolonged partial sleep paralysis in the same patient is a rare condition. We present a case of 42 years gentleman who presented with recurrent episodes of sleepwalking and prolonged incomplete sleep paralysis. He was on tablet divalproate 1000mg/ day and tablet olanzapine 5mg/day in view of a psychotic episode that occurred 4 years ago. Polysomnography suggested presence of moderate obstructive sleep apnea (OSA) with intrusion of alpha waves in sleep. Considering only one psychotic episode with no other risk factors, these medications were gradually tapered and discontinued. Symptoms improved after tablet clonazepam 0.5mg at bedtime even while he was not compliant to continuous positive airway pressure (CPAP).

Bronchoscopy is an extremely useful diagnostic and therapeutic procedure that finds an invaluable place in Pulmonology practice. Due to aerosol generation, bronchoscopy carries a high risk of infection transmission to health care workers and other patients. This fact is even more important in the present times of COVID-19 pandemic owing to its droplet- (and possibly aerosol-) mediated spread. With this background, a working group extracted literature through electronic search of PubMed and Google Scholar databases. All relevant documents were comprehensively reviewed and consensus recommendations formulated based on the level of available evidence. Where evidence was insufficient, Usual Practice Points were formulated based on expert opinion. This resultant document attempts to present clinical recommendations for performing flexible bronchoscopy in COVID-19 suspect/confirmed patients. It outlines important general considerations for bronchoscopy in these cases, provides an algorithmic approach to patient selection for bronchoscopy during these extraordinary times, and enlists critical do's and don'ts that should be followed before, during, and after the procedure. To conclude, flexible bronchoscopy must be cautiously performed amid the COVID-19 crisis. Judicious case selection and meticulous contact and airborne precautions are important to minimise infection transmission.

This case is being reported to draw the attention of non-cardiac practicing physicians including pulmonologists, intensivists, and, as a matter of fact all primary care and emergency clinicians, towards a relatively uncommon ECG finding that could be the potential lead in suspecting the diagnosis of a commonly encountered, often fatal medical condition. Together with a high clinical index of suspicion, this alone could guide the decision-making process for further work-up and specific therapy.