Lung India最新文献

Abstract: Polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea (OSA), but it poses significant barriers in resource-limited settings. The Belun Ring, a new home sleep apnea testing device utilising photoplethysmography and deep learning analysis, offers an alternative approach for diagnosing OSA. Herein, we present our initial experience with this device. Simultaneous in-lab PSG and Belun Ring assessments were conducted in six consecutive adults with suspected OSA undergoing PSG. Diagnostic performance was assessed by comparing the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) derived from both modalities. Belun Ring demonstrated a strong correlation with PSG AHI and ODI (Pearson's r = 0.98 for both; P < 0.001), but misclassified OSA severity in 50% of cases, mainly underestimating moderate disease. The device had a sensitivity of 83% for diagnosing OSA. This case series demonstrates the feasibility of Belun Ring use in an Indian population, but frequent severity misclassification is a concern, limiting its diagnostic applicability.

Abstract: Benign esophago-pulmonary fistula (EPF) is a rare clinical condition. This report highlights the case of a 58-year-old woman with a 10-year history of recurrent episodes of cough, throat irritation, dyspepsia and recurrent haemoptysis. Upper gastrointestinal (GI) endoscopy and chest CT detected a fistulous communication between the mid-oesophagus and the right lower lobe lung parenchyma, with bronchiectatic changes in the lower lobe. This patient underwent a video-assisted thoracoscopic surgery (VATS) division of EPF with right lower lobectomy. Intraoperatively, the fistula was identified on esophagoscopy and was divided after ensuring complete fistula closure without compromising the oesophageal lumen. She had an uneventful recovery in the postoperative period. This case highlights the importance of a minimally invasive VATS approach in managing complex benign thoracic fistulas, offering reduced morbidity and faster recovery compared to open thoracotomy.

Abstract: The treatment of bronchial asthma is complex and includes both pharmacological and non-pharmacological approaches. The main goals of therapy are to achieve and maintain disease control, minimize symptoms, prevent exacerbations, and improve the patient's quality of life. Inhaled corticosteroids (ICSs), bronchodilators, and biological therapy play a key role in severe forms of asthma. Patient education, identification and elimination of triggers of asthma attacks, and regular monitoring of the condition are also an integral part of disease management. Research in asthma management points to new therapeutic options that are tailored precisely to the endotype of the disease and the phenotype of the patient. Early diagnosis and individually tailored treatment are key factors to achieve remission and improve the prognosis of patients with bronchial asthma.

Background and objective: Obesity hypoventilation syndrome (OHS) includes morbid obesity (Body mass index>30 kilograms/m2), daytime hypercapnia (arterial carbon dioxide level >45 mm Hg) with features of sleep disordered breathing. Data are scarce in the management of acute-on-chronic hypercapnic failure with NIV, especially from developing countries like India. We set out to evaluate the demography of OHS patients presenting with acute on chronic hypercapnic failure and evaluate the effect of NIV in improvement of symptoms and correction of blood gas parameters.

Materials and methods: This ambidirectional observational study included 30 patients who were confirmed cases of OHS and were admitted with hypercapnic respiratory failure and managed with NIV and discharged later on domiciliary NIV. The patients were evaluated for the complications of OHS and were followed up for improvement with domiciliary NIV.

Results: Out of the 30 patients of OHS,16 (53%) were males while 14 (47%) were females. 17 patients (56.7%) had type II diabetes mellitus, while 25 (83%) patients were known cases of primary hypertension. The mean age was 61 years (SD-11.15), and the mean Body Mass Index (BMI) was 36.2 kilograms/meter2 (SD-6.19). On admission, the mean pH was 7.35 (SD-0.10), mean pCO2 was 55.33 mmHg (SD-17.56), and mean HCO3 was 31.31 (SD-5.23), suggestive of acute on chronic hypoventilation. 10 out of 30 patients were hypoxic at presentation, out of which 5 required (Non-Rebreathing Mask (NRBM on admission. All these patients were managed with NIV, and they showed significant clinical improvement in the form of improved sensorium, decreased oxygen requirement, and improved exercise tolerance. The mean improvement in pH after one week was 7.41, and the mean level of pCO2 was 48.10 mmHg after 1 week of NIV. Significant improvements were observed in arterial blood gases (pCO2 reduced from 55.33 ± 6.1 mmHg to 48.22; P<0.001) and Epworth Sleepiness Scale (ESS) scores. The decrease in pCO2 was statistically significant. These patients were discharged on domiciliary NIV and were followed up on an OPD basis.

Conclusion: All patients with OHS who presented with acute on chronic hypercapnic failure responded well to NIV therapy with significant improvement in exercise tolerance, weight loss, decreased symptom burden, and blood gase parameters. These findings reinforce the role of structured NIV therapy in OHS management.

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.

Abstract: Bronchoscopy, essential for respiratory diagnosis and treatment, carries a risk of post-procedural bleeding, especially in procedures like transbronchial lung biopsies (TBLB). This review evaluates tranexamic acid (TXA) for managing post-procedural bleeding in bronchoscopy. TXA is a synthetic lysine analog that inhibits plasminogen activation and promotes clot stability, therefore preventing and reducing bleeding. Evidence suggests that both topical and systemic administration can effectively reduce the incidence and severity of post-bronchoscopy bleeding. While generally well tolerated, considerations for TXA use include patient selection and awareness of potential risks, such as thromboembolic events. Further research is needed to establish optimal dosing regimens, administration routes, and long-term safety profiles to fully integrate TXA into bronchoscopy practice.