Lancelot Mark Pinto

Background: This study aimed to explore whether multiplex polymerase chain reaction (PCR) testing data could offer insights into trends in respiratory pathogens at a tertiary care centre in Mumbai, India. Materials and Methods: A retrospective observational study at a tertiary care hospital in Mumbai, India was conducted using data from BioFire ^® FilmArray Respiratory Panel tests performed between 2022 and 2024. The test detects 15 viral and bacterial respiratory pathogens. Data of patient demographics, clinical setting and detected pathogens were extracted. Results: A total of 3013 tests were conducted over 3 years, of which 50.4% detected at least one pathogen. The highest volume of testing occurred during the monsoon season (July–September), with Rhinovirus/Enterovirus being the most frequently detected organism overall. Influenza A (H1N1) was the predominant pathogen in intensive care unit patients, while respiratory syncytial virus and human metapneumovirus (HMPV) showed distinct seasonal peaks. A significant surge in HMPV cases was observed in 2024. Conclusion: The findings of this study demonstrate the potential for routine diagnostic data to function as a valuable surveillance tool. Integrating multiplex PCR results into real-time dashboards could enhance early outbreak detection, facilitate data-driven communication strategies and improve public health response to emerging epidemics.

COPD is the 2nd leading cause of death in India but is underdiagnosed, as spirometry is often inaccesible. CAPTURE (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk)is a short,5-item questionnaire, and PUMA is a 7-item questionnaire developed to screen patients for symptomatic COPD in primary care. Aim:To estimate the accuracy of CAPTURE and PUMA questionnaires for screening for spirometric COPD. Methods: Healthy subjects at a health screening were administered the PUMA and CAPTURE questionnaire. COPD was diagnosed if FEV1/FVC ratio =2 was abnormal for the CAPTURE and >= 5 for the PUMA questionnaire. Spirometry data were obtained. We analyzed whether the inclusion of a peak expiratory flow rate with a cut-off of 350L/min could improve accuracy. Data were anaylzed using STATA ver 15. Results: 355 participants were enrolled. Mean age was 51.5 years, 152(43 %)female. 12 subjects (3.3%) had spirometric COPD. PUMA questionnaire was found to have excellent NPV (97.6%) and specificity (98.2 %). CAPTURE questionnaire had a NPV of 97% and specificity of 87.4%. The NPV improved when combined with a peak expiratory flow rate < 350L/min. Conclusions: Both questionnaires perform well to rule out COPD, but had a poor sensitivity. Peak expiratory flow rates in the algorithm might improve the specificity, thereby decreasing the need for spiormetry. erj;64/suppl_68/PA2152/F1 F1 F1

There are limited well-designed studies on food-based interventions for improving sleep quality. Almonds are rich in bioactive phytochemicals, magnesium, zinc and melatonin, all of which are known to promote sleep Aim: To study the effect of almond consumption in adults on sleep quality Methods: Community-based participants were screened using self-administered Pittsburgh Sleep Quality Index (PSQI) and Epworth sleepiness scale(ESS). Those with PSQI ≥ 5 and ESS ≥ 10 were enrolled in the 20-week trial and randomized to intervention group (receiving 60gm almonds/day) or control (isocaloric snack). Overnight polysomnography test, PSQI and ESS were conducted at baseline and at 20 weeks. The data was analysed using STATA ver15 Results: 64 subjects have completed the study. Mean age of the participants was 45.3 (SD 8) years. Baseline PSQI and ESS scores, sleep efficiency (SE), sleep latency and wake after sleep onset (WASO) were similar (Table 1). In the intervention group, the mean PSQI at baseline was 7.14 (SD 3.2) which statistically significantly decreased to 5.00 (SD 2.10). Similar changes were also noted in the ESS, sleep efficiency and WASO. These changes were superior to those in the control group (Table 2) Conclusion: Addition of almonds in the diet had a beneficial impact on subjective and objective sleep quality as compared to a control intervention in individuals with a poor sleep quality erj;64/suppl_68/PA859/F1 F1 F1

The Pittsburgh Sleep Quality Index (PSQI) is a validated questionnaire to assess sleep quality. Polysomnography (PSG) objectively measures sleep quality with parameters such as sleep efficiency (SE) and wake after sleep onset (WASO). Aim: To test the association between PSQI and polysomnographic measures of sleep quality in adults from Mumbai, India Methods: Community-based participants were screened using self-administered PSQI and Epworth Sleepiness Scale(ESS). Those with PSQI score ≥ 5 and/or ESS score ≥ 10 were recruited, and overnight PSG was conducted. The data were analysed using STATA ver 14. Results: Mean age of participants was 40.2(SD 10.5) years; 79.6%(n=133) females. Mean PSQI was 7.53 (SD 3.07). Mean SE and sleep latency using PSG was 83.6% (SD 6.7)% and 39.6 (SD 26.1)min, respectively, correlating with derived values from the PSQI: 83.9 (SD 14.6)% and 30.7 (SD 29.3)min, respectively. The mean WASO with PSG was 43.5 (SD 30.7) min. 37.1 % participants (n=62) had mild sleep apnea, 12.6% (n=21) moderate sleep apnea and 5.4%(n=9) severe sleep apnea. PSQI had a significant correlation with sleep efficiency (r=-0.281, p=0.000) and with WASO (r=0.244, p=0.001) – Fig 1. Those in the third tertile of PSQI (>8) had the lowest sleep efficiency (81, SD 8.2%)., and longest WASO (53.7, SD 41.1 min). Conclusion: PSQI has a good correlation with PSG-derived sleep quality. There is a need to rule out sleep apnea if clinical suspicion is high. erj;64/suppl_68/PA2687/F1 F1 F1

Introduction: COPD is the third leading cause of mortality worldwide, and is often undiagnosed, especially in low- and middle-income nations. CAPTURE (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk) is a short, five-item screening questionnaire developed to screen patients for symptomatic COPD in primary care. Its accuracy at community screening has not been determined. Aims and Objectives: To determine the accuracy of CAPTURE in identifying symptomatic subjects with COPD at a health screening. Methods: Consecutive subjects ≥18 years of age with no diagnosed respiratory illness undergoing spirometry as a part of health screening were enrolled. Consenting subjects were requested to complete the CAPTURE questionnaire. COPD was diagnosed based on a fixed FEV1/FVC ratio =2 was considered abnormal for the questionnaire. We aimed to determine the accuracy of CAPTURE questionnaire at identifying undiagnosed clinically significant COPD. Results: From November 2022-Feb 2023, 1453 individuals were screened. Mean age was 52 years (SD=12) with 60% males. 51(3.51%) were diagnosed to have COPD by spirometry criteria (28,28 and 3 subjects in GOLD stage 1,2 and 3, respectively). The CAPTURE questionnaire had an excellent negative predictive value for COPD (97.8%, CI 96.8,98.6). 16 of the 24 individuals with COPD not screened by the questionnaire had GOLD 1 COPD, suggesting that a majority of those with moderate to severe COPD were screened. Conclusion: The CAPTURE is an easy-to-use accurate questionnaire which can be deployed in screening individuals in the community for the early detection of COPD.

Background: WHO has reported greater than 6.8 million deaths due to COVID-19. Identifying predictors of clinical deterioration and death would be useful in triaging and prioritizing such patients for early interventions. Aims and objectives: To identify the sociodemographic, clinical, laboratory, and radiological predictors of deterioration among patients hospitalized with COVID-19. Methods: Consecutive patients with COVID-19, hospitalized over one year at the P.D.Hinduja hospital,which is a tertiary care center in the city of Mumbai, were included. Results: 1000 patients were included;62% were male.17% were transferred to intensive care. In the multivariable analysis, independent predictors for ICU transfer were underlying malignancy(OR 5.7 (95%CI 2.35-13.83), X-ray/CT involvement(OR 21.9 (95%CI 12.15-39.75), and elevated levels of serum creatinine(OR 1.8 (95% CI 1.04-2.93) at admission. 2% of patients expired during hospital stay; Chest X-ray/CT involvement and elevated creatinine were associated with mortality. 14.3% of patients had a prolonged hospital stay;age over 60(OR 1.6(95%CI 1.13-2.28),low total white blood cell count(OR 2.4 (95%CI 1.52-3.65), and low absolute neutrophil count(OR 1.04 (95%CI 0.68-1.58) were independent predictors. 9.5% of patients required oxygen at discharge; elevated D-dimer levels(OR 1.76,95%CI 1.13-2.74) and Chest X-ray/CT involvement were predictors. Conclusion: An underlying malignancy was the strongest clinical predictor of deterioration, with radiological involvement and altered renal function being important predictors of poor outcomes. Such patients could benefit with early aggressive intervention with medications such as antivirals and monoclonal antibodies.

PRISm is defined as preserved ratio(FEV1/FVC>0.7) but impaired spirometry (FEV1 and/or FVC<80% of reference). Individuals with PRISm may be at risk of developing airflow obstruction, and have been reported to have worse health outcomes. To determine the prevalence and characteristics of subjects with PRISm in a health screening population. Consecutive subjects ≥18 years with no diagnosed respiratory illness undergoing spirometry as a part of health screening were enrolled. Participants were requested to complete the CAPTURE questionnaire (screening for COPD) and mMRC questionnaire. Those with PRISm were compared with those who had a normal spirometry. From November 2022-Feb 2023, 1453 individuals were screened. Mean age was 52 years (SD=12) with 60% males.51(3.51%)were diagnosed to have COPD by spirometry, and 119 (8.19%)subjects had PRISm (35 by FVC criterion, 19 by FEV1 criterion, 65 by both). In the univariate analysis those with PRISm were statistically significantly (p<0.05)older, male, had a higher BMI, and were more likely to be diabetic, hypertensive, or have heart disease. They were significantly more breathless on the mMRC scale and had higher CAPTURE scores. In the multivariable analysis, male gender, age and BMI were statistically significantly predictive variables. Subjects with PRISm appear to have poorer health status and should be followed over time. The prevalence appears to increase in men, with age and those with higher BMI.