Lung India最新文献

Abstract: Choriocarcinoma is an aggressive malignant trophoblastic tumour of rare occurrence, which often presents with multiple metastases, including lungs, brain, liver, kidneys, and lymph nodes. However, primary choriocarcinoma of the pulmonary artery is an even rarer and highly malignant clinical entity that is difficult to diagnose and treat timely. Less than 15 cases have been reported so far in the literature. In this case report, a 38-year-old female presented with recurrent pulmonary thromboemboli despite being on adequate anticoagulation. Positron emission tomography/computed tomography (PET/CT) showed an abnormally hypermetabolic uptake in the pulmonary artery thrombi, suggesting tumour emboli. Catheter-guided aspiration thrombectomy followed by pathological examination confirmed non-gestational choriocarcinoma originating from the pulmonary arteries. The patient underwent treatment under a medical oncologist and responded well to the treatment. A literature search revealed only 12 reported cases. Diagnosis of primary pulmonary artery choriocarcinoma requires a high index of suspicion. Suspicion rises manifold when a reproductive age group female presents with recurrent pulmonary thromboembolism with raised serum βhCG levels.

Background: Post-mortem tissue sampling can help determine the cause of death, particularly in resource-limited settings. We conducted a retrospective audit of minimally invasive autopsies (MIA) performed in a respiratory intensive care unit.

Methods: Lung biopsies were obtained using either a core biopsy needle (CBN) or through a small thoracic incision at the fourth intercostal space (open incision method [OIM]). We performed a kidney or liver biopsy using a CBN with ultrasound guidance. The final cause of death, ascertained by a multidisciplinary team, served as the reference standard. The primary objective was to assess biopsy yield and the frequency of diagnostic revision based on histopathological findings.

Results: One hundred and sixteen patients underwent MIA. Lung biopsies were done in all cases (66 [56.9%] by CBN and 50 [43.1%] by OIM). Kidney and liver were biopsied in less than 10% of cases. Twelve biopsies (10.3%) were non-representative and excluded from further analysis. The overall biopsy yield was 74%. Pathological findings led to a change in the final diagnosis in three cases (2.9%). Infections aetiologies were most common, including bacterial pneumonia (24, [23.1%]), fungal pneumonia (8, [7.7%]), and tuberculosis (2, [1.9%]). Malignancy was identified in 8 (7.7%) cases. The diagnostic yield was significantly higher with OIM than with CBN (87.5% vs. 62.5%, P = 0.004). Agreement between clinical and pathological diagnoses was fair (kappa = 0.41, P < 0.001).

Conclusion: MIA achieved a 74% diagnostic yield with fair agreement with the MDT-determined cause of death. OIM provided a superior yield compared to CBN and may be preferable where feasible.

Background: Paediatric drug-resistant tuberculosis (DR-TB) remains a significant challenge, especially in high-burden countries like India. While bedaquiline (BDQ) and delamanid (DLM) are shown to be successful in treating multi-drug-resistant TB (MDR-TB) in older children, evidence of their safety and effectiveness in children under 5 is limited. We set out to evaluate the clinical outcomes and safety of BDQ and concurrent BDQ and DLM-based regimens in children under 5 years with DR-TB in a tertiary care Mumbai, India.

Methods: A retrospective study was conducted on 23 children under 5 years diagnosed with DR-TB and treated with BDQ or BDQ and DLM-based longer oral regimens between December 2021 and May 2024. Data on treatment regimens, drug resistance patterns, adverse effects, and outcomes were collected. Treatment was stopped based on clinico-radiological response.

Results: Among the 23 children, 8 (34.78%) completed treatment, 12 (52.17%) were still undergoing therapy, 1 (4.34%) was lost to follow-up, and 2 (8.69%) died. For those who completed treatment, the average duration of treatment was 19.25 months. Weight gain was observed in 19 (82.6%) patients. Adverse drug reactions were noted in 8 (34.78%) patients, of which 2 (25%) had vomiting, 2 (25%) had hallucinations, 1 (12.5%) had psychosis, 4 (50%) had anaemia, and 3 (37.5%) had QTcF prolongation while on treatment.

Conclusion: BDQ and DLM-based regimens appear effective and generally well tolerated in treating DR-TB in children under 5. However, a longer course of treatment of over 18 months is required. Careful monitoring for side effects, especially QTc prolongation, remains critical.

Purpose: This study aimed to investigate the effects of pulmonary rehabilitation on symptom change and exacerbations in patients with chronic obstructive pulmonary disease (COPD).

Methods: This randomised controlled trial enrolled COPD patients from Shangrao Municipal Hospital between June 2022 and June 2024. The patients were randomly allocated to control and pulmonary rehabilitation groups. Data on demographics, pulmonary function, COPD assessment test (CAT) scores, modified Medical Research Council scores, and inhalation therapy regimens were collected. The patients in the pulmonary rehabilitation group were undergoing pulmonary rehabilitation sessions twice weekly for 6 months. The number of exacerbations and CAT scores were recorded during 6 months of intervention period. The minimum clinically important difference (MCID) was defined as a CAT score decrease of ≥2 at 6-month visits from baseline.

Results: A total of 188 patients with COPD were enrolled and randomly allocated to the control and pulmonary rehabilitation groups. There were no significant differences in clinical characteristics between the control and pulmonary rehabilitation groups. Patients in the pulmonary rehabilitation group were more likely to attain MCID and had lower risk of future exacerbations and hospitalizations during 6 months of intervention period than patients in the control group (P < 0.05). Comparison of the exacerbation proportion using a Kaplan-Meier curve revealed that the patients in the pulmonary rehabilitation group had a lower risk of future exacerbations (P < 0.05).

Conclusions: Pulmonary rehabilitation is effective for improving symptoms and decreasing future exacerbations in COPD patients. A pulmonary rehabilitation program should be recommended for the daily management of COPD patients.

Introduction: Antifibrotic therapies are widely used in both idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). We aim to compare the demographic, clinical characteristics, and long-term outcomes of IPF and PPF patients on antifibrotic treatment at 6-month and 1-year follow-ups.

Methods and materials: This was a retrospective single-center cohort study. Between January 2021 and January 2025, patients who initiated antifibrotic therapy were retrospectively included. Pulmonary function tests were recorded before treatment, at baseline, and at 6-month and 1-year follow-up visits. Additionally, baseline 6-minute walk test results and radiological data were also documented.

Results: A total of 117 cases were included in the study, consisting of 76 IPF and 41 PPF. IPF patients were statistically significantly older than PPF patients (P < 0.001). The proportion of females was higher in the PPF group (P < 0.001). 52% of the cases used pirfenidone, while 48% used nintedanib. The most common subtype of PPF was connective tissue disease-associated ILD (48.8%), followed by nonspecific interstitial pneumonia (34.1%), and hypersensitivity pneumonitis (17.1%). In the PPF group, basal, 6-month, and 1-year follow-up FVC and DLCO values were statistically significantly lower compared to the IPF group. However, in both the IPF and PPF groups, no significant loss was observed in FVC and DLCO when comparing the 6-month and 1-year follow-up data with baseline values. No significant difference in mortality was found between the IPF and PPF groups.

Conclusions: Antifibrotic treatments showed a similar effect profile for both IPF and PPF. Our findings suggest that PPF patients with lower baseline pulmonary function require closer monitoring for early detection of progression.