Lung India最新文献

Background: There are guidelines recommending the use of Indwelling pleural catheter (IPC), but there is no established consensus or guidelines regarding the modality of drainage post-IPC insertion. We have devised a novel drainage technique that combines the advantages of both aggressive and symptom-guided drainage.

Method: This was a prospective intervention trial in which patients with malignant pleural effusion, drained with IPC, were initially given one week of 'high-intensity' drainage on an outpatient basis using a low-pressure suction pump, followed by symptom-based home drainage using vacuum bottles. Patients were assessed for improvement in breathlessness, the number of autos pleurodesis, and the number of vacuum bottles consumed.

Results: A total of 25 patients with malignant pleural effusion who satisfied the inclusion criteria were selected. The mean breathlessness as per the visual analogue scale (VAS) was 87 before the insertion of IPC, which decreased to 48.2 immediately after IPC insertion and drainage. The 'high-intensity' drainage was able to maintain this fall in VAS. Thirteen patients (52%) achieved pleurodesis, of which 10 achieved pleurodesis after 5 weeks of IPC insertion, and 3 achieved pleurodesis after 7 weeks of IPC insertion. Eleven patients (44%) had the IPC in situ until death. One patient had the IPC removed due to empyema. None of the 10 patients who achieved pleurodesis within 5 weeks of IPC insertion had to use vacuum bottles at home for 'symptom-guided' fluid drainage.

Conclusion: This novel method of draining malignant pleural effusion brought about symptomatic improvement, increase auto-pleurodesis, and thereby reduce the number of vacuum bottles consumed in the study population.

Background: The need of pulmonary rehabilitation (PR) for COVID-19 patients with long-term effects was desperately felt. The study's objective was to measure the effect of PR on functional capacity and health-related quality of life (HRQOL) in patients with post COVID conditions.

Methods: Pulmonary medicine department of a teaching hospital conducted this pre-experimental study. The patient underwent a pre and post-assessment, including a six-minute walk test (6MWT) measuring distance, oxygen desaturation, pulse rate, and HRQOL. The intervention had six components; education to patients and caregivers, breathlessness relieving exercises, postural correction, aerobic training, strength training, and stretching exercises. These activities were carried out twice a week for eight weeks, supervised, unsupervised in homes, and a combination.

Results: The study enrolled 155 post-COVID patients (Males, 102 and female, 53), out of which 28 (18.1%) had mild, 55 (35.5%) had moderate and 72 (46.5%) had severe COVID. Paired t-test showed improvement in resting pulse rate (P = 0.001) and resting oxygen saturation (P < 0.0001). Distance walking for six minutes increased after rehabilitation (P < 0.0001). After eight weeks of pulmonary rehabilitation, there was an improvement (P < 0.001) in all domains of quality of life, that is, mobility, self-care, pain and discomfort, usual activity, sleep, anxiety and depression.

Conclusion: Pulmonary rehabilitation is beneficial for post-COVID patients in improving their quality of life and six-minute walk test parameters, resulting in improved functional capacity and overall quality of life.

Abstract: The European Respiratory Society (ERS) and the British Thoracic Society (BTS) have recently published their statements on the treatment of sarcoidosis. There are five key questions in sarcoidosis treatment that need to be addressed: when to treat, how to initiate treatment, how long to treat, when and how to change treatment, and how to treat relapses. Herein, we describe the principles and protocols to answer these questions based on the ERS and BTS statements and other expert reviews. Pulmonary or extrapulmonary sarcoidosis should be treated with anti-inflammatory therapy if it significantly impairs the quality of life (QoL), causes significant organ dysfunction, or threatens to cause organ damage, disability, or death. If treatment is initiated for improving the QoL alone, low-dose (10 mg/day) prednisone is a good initial treatment that can be tapered and stopped over 3 months. Disease that causes significant organ dysfunction needs to be treated with medium-dose glucocorticoids (initial daily dose, 20 mg of prednisone equivalent) tapered over a minimum duration of 6 months. Worsening of disease while tapering treatment indicates that longer (9-24 months) treatment may be necessary. If a daily prednisone dose of >10 mg is required for >6 months to maintain remission, it is best to use a second-line drug such as methotrexate or azathioprine. Anti-tumor necrosis factor agents, such as infliximab or adalimumab, may be used to treat inflammatory disease that persists on combination treatment with glucocorticoids and a second-line agent.

Background: Biomarkers like sarcopenia, eosinopenia and C-reactive protein (CRP) may predict major adverse events including intubation, ICU admission, mortality and readmission in chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to determine their prognostic utility and accuracy.

Methods: This was a prospective analysis of COPD patients hospitalised for acute exacerbation over one year. Patients with primary diagnoses other than COPD were excluded. Patients were screened to select a sample of 205 participants, with 55 experiencing adverse events including intubation, ICU admission, in-hospital mortality and 30-day readmission. Data on demographics, lung function, symptoms, nutrition, frailty, sarcopenia, eosinophil-to-platelet ratio (EPR) and CRP were extracted. Differences between groups were analysed using t-tests and regression modelling.

Results: EPR <0.755 and CRP ≥15.8 mg/dL were significant predictors of adverse events after adjustment, with EPR having an AUC of 0.79 and CRP an AUC of 0.68 for composite outcomes. In multivariate analysis, sarcopenia, EPR and CRP remained significant with the outcome variables (intubation, ICU admission, in-hospital mortality and 30-day readmission).

Conclusion: EPR and CRP are useful prognostic markers of clinically significant in-hospital outcomes during COPD exacerbations. However, a multidimensional approach may further optimise risk prediction.

Background: Cyclin D1 is a protein that can enhance the proliferation of cancer cells and has been detected in various malignancies, including lung cancer. However, routine examinations for Cyclin D1 in lung cancer cases have not been conducted in Kerala.

Aim: This study sought to evaluate the links between cyclin D1 expression, clinicopathological characteristics, and 2-year survival rates in lung cancer.

Methods: This retrospective cohort study used medical records and paraffin blocks of lung cancer patients at the Regional Cancer Centre in Kerala, India, between 2015 and 2018. The data were collected from 61 subjects, comprising of lung adenocarcinoma (18%), lung squamous cell carcinoma (27.9%), non-small-cell lung carcinoma (18%), poorly differentiated carcinoma (19.7%), and negative for malignant cells (16.4%). Data analysis was conducted using SPSS.

Results: The study revealed that 31.10% of the lung cancer patients exhibited overexpression of cyclin D1. A significant correlation was observed between cyclin D1 expression and histopathological results (P = 0.002), indicating that the level of cyclin D1 might be linked to specific histopathological subtypes of lung cancer. Despite this significant finding, cyclin D1 expression did not show any association with the clinical stage of the cancer or other clinical characteristics of the patients. Furthermore, when examining the 2-year survival rates of the patients, the study found no significant difference between those who had overexpression of cyclin D1 and those who did not (P = 0.145).

Conclusion: Cyclin D1 expression was associated with histology type of lung cancer with no significant association to prognosis.