Assimilative capacity of the atmosphere at Gorakhpur with respect to air pollution

The present study aims at seasonal and diurnal pollution potential at Gorakhpur in east Uttar Pradesh. To assess the pollution potential, meteorological data for five year period (1982-86) of Gorakhpur have been analyzed for four seasons viz; winter (December-February), summer (March-May), monsoon (June-September) and post monsoon (October-November). Season wise wind roses, stability, stability wind roses have been prepared and season wise diurnal variation of mixing height and ventilation coefficient have also been worked out. It is found that Gorakhpur has a better diffusion capacity in summer and poor in post monsoon followed by winter. Afternoon hours are better for vertical mixing. The winds are predominantly from southwest to west in all seasons except in monsoon when it blows from northeast to east. Based on this study, an appropriate location for industrialization has been suggested.

A systematic review of the systematic review of post COVID-19 syndrome

Background: The declaration of the COVID-19 pandemic triggered a global inquiry into the transmission, mortality, risk factors, and management of the disease. Recently, however, attention has shifted toward its long-term consequences. There is a need for a better understanding of the predictors and symptoms of post-COVID syndrome, to ensure appropriate care for patients recovering from COVID-19 beyond the acute phase. Methods: We searched PubMed, Google Scholar, Cochrane databases, and available data in the PROSPERO databases. We also explored the reference lists of included articles and any systematic reviews identified therein. We searched the keywords "Post Covid", "Post COVID syndrome", "Post- Covid" and "PostCOVID", until July 2021. Results: Of 8167 articles, 13 were included. The syndrome affects several systems with variable prevalence. Fatigue and sleep disturbance is the most common symptom of acute post-COVID syndrome, observed in more than two-thirds of patients, while a reduction in quality of life and general health status was noted in up to 69%. Furthermore, a reduced aerobic and diffusion capacity was seen in 38% of patients up to one month after presumed recovery from infection. Radiologically, in up to 52% of patients, a ground-glass opacity (GGO) was noted beyond three months post-infection. The incidence of new psychiatric illness increased from as early as 14 days after infection and up to three or six months. Hearing impairment or loss, whether sensorineural or conductive, was noted in up to 8.3% of patients, and tinnitus was seen in up to 4.2%. Conclusion: Overall, given the variability in the manifestation of post-COVID syndrome, a multidisciplinary team is required to better serve these patients. We therefore urge the establishment of such teams, encompassing internal medicine, pulmonology, cardiology, and neurocognitive services.

Carbon Monoxide Diffusion Capacity as a Severity Marker in Pulmonary Hypertension

Carbon monoxide diffusion capacity (DLCO) is negatively associated with patient survival in idiopathic pulmonary hypertension (PH), but is not included in the risk stratification score proposed by the 2015 European guidelines. Since 2015, several new stratification scores based on a 3- or 4-severity scale have been explored. This retrospective cohort single-center study sought to investigate the association between DLCO and PH severity and survival. We included 85 treatment-naive patients with precapillary PH and DLCO measurement at diagnosis. DLCO status, based on lower and upper quartiles ranges, was added to a 3- and a 4-strata modified-risk assessment. DLCO was strongly associated with transplant-free survival (HR 0.939, 95% CI: 0.908–0.971, p < 0.001). In the intermediate and high-risk categories, DLCO was associated with transplant-free survival, irrespective of the risk category (HR 0.934, 95% CI: 0.880–0.980, p = 0.005). The correlation between modified-risk category and transplant-free survival was significant (HR 4.60, 95% CI: 1.294–16.352, p = 0.018). Based on the Akaike information criterion (AIC) levels, the 3- and 4-strata modified-risk stratification fits our results better than the conventional stratification. Low DLCO is associated with patient transplant-free survival, independently of the risk category. Inclusion of DLCO into a PH risk stratification score seems promising and needs further investigation.

Assessment of the effectiveness of medical rehabilitation after COVID-19 based on the functional capacity of the cardiovascular and respiratory systems

Aim. To assess the effectiveness of medical rehabilitation after pneumonia associated with the novel coronavirus infection (COVID-19), based on the study of functional capacity of the cardiovascular system and the external respiratory system.Methods. The study included 70 patients who had COVID-19 pneumonia and underwent a medical rehabilitation program from September to December 2020. Before being included in the rehabilitation program, all patients underwent pulmonary function tests (PFT), including an assessment of the lungs diffusion capacity, cardiopulmonary exercise testing, multispiral computed tomography (MSCT) of the chest, echocardiography, an evaluation of the quality of life according to the SF-36 questionnaire and the severity of shortness of breath on the mMRC scale. The effectiveness of rehabilitation was evaluated against the changes in PFT parameters, exercise tolerance, and quality of life.Results. At the enrollment, 46% of patients retained lung tissue lesions shown by MSCT and accompanied by a decrease in the lung diffusion capacity (67 (55 - 79%) of predicted value), dyspnea of 1.6 (1.0 - 3.0) points according to mMRC scale, moderate level of exercise tolerance and quality of life. Complex cardiopulmonary rehabilitation for 12 - 14 days in a specialized hospital led to a significant improvement in the parameters of pulmonary gas exchange and ventilation, peak oxygen consumption, and an increase in the reserve capacity of the cardiorespiratory system. The factors limiting the improvement of pulmonary gas exchange were the older age of the patients and the increased pressure in the pulmonary artery system. The positive influence of rehabilitation on both the physical and psycho-emotional components of the quality of life was noted.Conclusion. Complex cardiopulmonary rehabilitation with the assessment of changes in the oxygen metabolism parameters and functional capacity of the cardiovascular and respiratory systems has shown to be safe and highly effective in the studied group of patients who have had COVID-19 pneumonia.

Longitudinal Assessment of Health and Quality of Life of COVID-19 Patients Requiring Intensive Care—An Observational Study

Long-term health consequences in survivors of severe COVID-19 remain unclear. Eighteen COVID-19 patients admitted to the intensive care unit at the University Hospital Rechts der Isar, Munich, Germany, between 14 March and 23 June 2020, were prospectively followed-up at a median of 36, 75.5, 122 and 222 days after discharge. The health-related quality of life (HrQoL) (36-item Short Form Health Survey and St. George’s Respiratory Questionnaire, SGRQ), cardiopulmonary function, laboratory parameters and chest imaging were assessed longitudinally. The HrQoL assessment revealed a reduced physical functioning, as well as increased SGRQ impact and symptoms scores that all improved over time but remained markedly impaired compared to the reference groups. The median radiological severity scores significantly declined; persistent abnormalities were found in 33.3% of the patients on follow-up. A reduced diffusion capacity was the most common abnormal pulmonary function parameter. The length of hospitalization correlated with role limitations due to physical problems, the SGRQ symptom and the impact score. In conclusion, in survivors of severe COVID-19, the pulmonary function and symptoms improve over time, but impairments in their physical function and diffusion capacity can persist over months. Longer follow-up studies with larger cohorts will be necessary to comprehensively characterize long-term sequelae upon severe COVID-19 and to identify patients at risk.

Impaired Diffusion Capacity and Pulmonary Fibrosis after Recovery from COVID-19: A Systematic Review and Meta-Analysis

Background: The medium- to long-term pulmonary consequences of coronavirus disease 2019 (COVID-19) after recovery from acute infection remain unclear. Several studies have examined this issue and reported heterogeneous results. Methods: We conducted a systematic review and meta-analysis using a random-effects model to estimate the pooled prevalence of pulmonary sequelae after COVID-19, namely impaired diffusion capacity and pulmonary fibrosis, at least 1 month after the initial infection. PubMed, Embase, and Cochrane Library were searched from January 1, 2020, to February 15, 2021 to identify related studies. We also assessed whether the initial severity of infection was associated with impaired diffusion capacity in the recovery phase. Results: Of the 8159 studies identified, 29 met our eligibility criteria. Among these studies, 25 and 20 had data on follow-up pulmonary function testing and chest computed tomography (CT), respectively. Impaired diffusion capacity (<80% of predicted values or lower limit of normal) was the most common pulmonary abnormality (pooled prevalence 34%, 95% CI 27%–41%). When classified according to the severity of index infection, patients with severe COVID-19 were more likely to display impaired diffusion capacity than those with non-severe COVID-19 (pooled odds ratio 2.97, 95% CI 2.10–4.20). On follow-up chest CT, pulmonary fibrosis was found in 26% (95% CI 17%–36%) of the patients. Conclusions: A substantial number of patients recovering from COVID-19 displayed impaired diffusion capacity and pulmonary fibrosis. The severity of index COVID-19 was associated with impaired diffusion capacity, highlighting the importance of respiratory follow-up in patients recovering from severe COVID-19.Systematic review registration number: PROSPERO CRD42021234357

Evaluation of the Pulmonary Function Test (PFT) in Patients Affected by Severe COVID-19 Pneumonia: 6 to 12 Weeks After Discharge

The most lethal adverse effect of COVID-19 is acute respiratory distress syndrome, which can lead to rapid death. This symptom even causes concern for patients who have recovered and have been discharged. Therefore, it is obligatory to test and monitor variations in their lungs’ function after recovery. In this study, we evaluated the pulmonary function of 64 patients with severe COVID-19, six weeks to 3 months after discharge. Pulmonary function parameters were measured by spirometry and body box according to the criteria of the American Thoracic Society and under the supervision of an adult pulmonologist. According to the forced expiratory volume (FEV1)/forced vital capacity (FVC) ratio and total lung capacity (TLC) values, it was found that 3.1% of people had an obstructive pattern, 40.63% of patients had the restrictive pattern, and 6.25% of improved individuals showed a mixed pattern. Furthermore, the study of diffusion capacity of carbon monoxide (DLCO) index revealed that 13.3%, 25%, and 53% of cases had mild, moderate, and severe disorders of gas exchange, respectively. In addition, determining the maximum amount of inspiratory muscles (PI max) and expiratory muscles (PE max) disclosed that the rate of these two indicators in 62.5% and 71.88% of the subjects were less than 50%, respectively. In general, the results of the present study suggest that pulmonary function test and follow-up of patients' condition are not only recommended but seems to be essential after recovery due to the large percentage of patients with the restricted pattern a few weeks after recovery.

The Effect of an Olympic Distance Triathlon on Pulmonary Diffusing Capacity and its Recovery 24 Hours Later

The Olympic distance triathlon includes maximal exercise bouts with transitions between the activities. This study investigated the effect of an Olympic distance triathlon (1.5-km swim, 40-km bike, 10-km run) on pulmonary diffusion capacity (DLCO). In nine male triathletes (age: 24 ± 4.7 years), we measured DLCO and calculated the DLCO to alveolar volume ratio (DLCO/VA) and performed spirometry testing before a triathlon (pre-T), 2 hours after the race (post-T), and the day following the race (post-T-24 h). DLCO was measured using the 9-s breath-holding method. We found that (1) DLCO decreased significantly between pre- and post-T values (38.52 ± 5.44 vs. 35.92 ± 6.63 ml∙min-1∙mmHg-1) (p < 0.01) and returned to baseline at post-T-24 h (38.52 ± 5.44 vs. 37.24 ± 6.76 ml∙min-1∙mmHg-1, p > 0.05); (2) DLCO/VA was similar at the pre-, post- and post-T-24 h DLCO comparisons; and (3) forced expiratory volume in the first second (FEV1) and mean forced expiratory flow during the middle half of vital capacity (FEF25-75%) significantly decreased between pre- and post-T and between pre- and post-T-24-h (p < 0.02). In conclusion, a significant reduction in DLCO and DLCO/VA 2 hours after the triathlon suggests the presence of pulmonary interstitial oedema. Both values returned to baseline 24 hours after the race, which reflects possible mild and transient pulmonary oedema with minimal physiological significance.

Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment

Background: Maintenance treatment with immune-checkpoint inhibition (ICI) has been shown to significantly improve patient prognosis after chemoradiotherapy (CRT) for inoperable stage III NSCLC. This survival advantage may be achieved at the expense of an increased probability for symptomatic pneumonitis as CRT as well as ICI treatment is associated with the risk of treatment-related pulmonary toxicity. Methods: We screened a prospective chemoradioimmunotherapy (CRT-IO) cohort consisting of 38 patients and identified patients with therapy-related grade 3 pneumonitis. All patients were treated with intravenous high dose corticosteroids and closely monitored by CT-scans and extended longitudinal lung function tests. We analyzed lung function parameters and CT morphological features to characterize patients’ outcome. Results: Six (16%) patients treated with CRT-IO developed grade 3 pneumonitis one to six months after completion CRT. In the CT imaging, pneumonitis was characterized by diffuse ground glass capacities and in part pulmonary consolidations within and outside the planning target volume. Onset of pneumonitis was accompanied by a reduction in diffusion capacity in all cases. The mean decline of diffusion capacity was 25.8% [6–53%]. Under treatment with corticosteroids, all patients recovered regarding symptoms and changes in CT morphology. In five out of six patients, diffusion capacity improved to at least 80% of the baseline [80–96%]. One patient showed a significant increase of diffusion capacity after treatment (from 32% to 53%) but reached only 62% of the initial value. Conclusions: Pneumonitis is a severe complication of CRT-IO. High-resolution CT imaging and extended lung function testing proved to be a suitable approach in detecting and monitoring of CRT-IO associated pneumonitis.