Lung India最新文献

Background and objective: We evaluated the DR-TB component of the National Tuberculosis Elimination Program (NTEP) in a high-burden district in Kerala to identify the programmatic gaps, if any, in screening, diagnosis, treatment, and follow-up of notified DR-TB patients.

Methods: A mixed-methods design was used, and the evaluation was performed in two steps. In the first step, we reviewed the program documents and conducted stakeholder interviews to develop a detailed description of the program design and developed a logical framework to evaluate program performance. Consequently, in the next step, we conducted programmatic data reviews, facility surveys, and in-depth interviews with key stakeholders to identify the programmatic gaps in implementation, guided by the logic framework.

Results: Of the 494 microbiologically confirmed TB patients during 2021-22, 342 (69%) were tested for drug sensitivity, and 30 DR-TB patients were identified. There was no separate district DR-TB treatment center with airborne infection control facilities, and only 16% (66/422) of the various categories of staff were trained in recent guidelines. Only 30% (9/30) of DR-TB patients were provided with any psychological assessment. The favorable treatment outcome was 80% Interviews revealed poor readiness and motivation from the private sector for screening, contextual barriers in human resource availability, transportation, and financial barriers to the beneficiary despite providing financial benefits.

Conclusion: Prioritizing the establishment of a district DR-TB treatment center and sputum transport mechanism, posting a clinical psychologist dedicated to counseling patients on therapy, and training all categories of staff on DR-TB management guidelines will significantly contribute to improving program outcomes.

Background: The estimated incidence of pulmonary embolism (PE) is around 60-70 cases per 100,000 people annually. The overall mortality rate for massive PE is substantial, ranging from 18% to 65%. We can utilise changes in lung perfusion to stratify patients with PE acutely based on risk, highlighting its diagnostic and prognostic value.

Objectives: To calculate the whole-lung perfused blood volume (PBV) and right-to-left ventricular diameter ratio from dual-energy computed tomography thorax in patients with acute PE and find its association with 28-day all-cause mortality.

Methods: This was a prospective diagnostic accuracy study at the Jawaharlal Institute of Post-Graduate Medical Education and Research. We included suspected acute PE patients. A dual-energy chest CT was performed on all these patients, and iodine maps were generated using the Syngo dual-energy workstation. Whole-lung PBVs were then calculated. Patients were followed up for 28 days, and all-cause mortality data were collected. The prognostic accuracy of PBVs in predicting mortality among acute PE patients was analysed using the ROC curve using SPSS version 19.0.

Results: The area under the curve (AUC) was 0.696, indicating a moderate discriminatory power in distinguishing between patients who experienced mortality and those who did not. An empirical cut-off value of 0.945 corresponds to a sensitivity of 63.2% and a specificity of 67.6%.

Conclusion: The prognostic accuracy of total perfused lung volume/total lung volume revealed a moderate discriminatory power, indicating 70% accuracy in predicting 28-day mortality based on standardised total PBVs.

Background and objective: Obstructive sleep apnea (OSA) is a common condition, featured by repetitive upper airway collapse during sleep manifested with poor quality of life and co-morbidities. Although continuous positive airway pressure (CPAP) is the recommended therapy, lack of patient compliance and persistent symptoms often preclude its success. The present study evaluates the effect of acetazolamide in combination with CPAP, and compares this treatment strategy to single therapy using CPAP in moderate to severe OSA.

Materials and methods: A parallel-group, open-label randomized controlled trial consisted of 95 subjects diagnosed with moderate to severe OSA. Subjects were randomly allocated in a 1:1 ratio to CPAP plus acetazolamide (C+D) and CPAP alone (C). The baseline characteristics and the apnea-hypopnea index (AHI) metrics were comparable. Following four weeks of intervention, the outcomes measured involved changes in AHI (apnea hypopnoea index), sleep architecture, ODI (oxygen desaturation Index), and other sleep parameters.

Results: The combination of CPAP and acetazolamide significantly reduced total AHI (34.69 ± 18.91 events/hour) compared to CPAP alone (45.47 ± 19.09 events/hour, p = 0.0044). AHI also observed significant improvements during non-REM sleep (p = 0.0014). Although no significant difference was found in AHI during REM sleep between the groups (p = 0.6284), the C+D group demonstrated a notable decrease in severe OSA cases and an increase in mild and moderate OSA classifications. Compliance-adjusted AHI was significantly lower in the C+D group (5.67 ± 3.45) compared to the C group (7.67 ± 3.41, p = 0.0034). The C+D group exhibited improved sleep architecture with lower percentages of N1 and N3 sleep stages, and a trend towards increased REM sleep percentage (p = 0.0704). Significant reductions in WASO (p = 0.0404) and ODI (p = 0.0301) were also observed. Both groups reported minimal and comparable side effects, indicating the safety and tolerability of the combination therapy.

Conclusion: The addition of acetazolamide to CPAP therapy improves efficacy in OSA treatment parameters among moderate-to-severe OSA, reduces total and NREM AHI as well as ODI without an increase in adverse effects. With added pharmacotherapy, the combination therapy represents a potential adjunctive treatment for managing OSA.

Chronic obstructive pulmonary disease (COPD) is a type of lung disease marked by permanent damage to tissues in the lungs. Over time, chronic obstructive pulmonary disease (COPD) can make breathing difficult due to permanent lung damage. COPD encompasses two main conditions chronic bronchitis, where inflammation and scarring narrow the large airways, and emphysema, where the tiny air sacs in the lungs are damaged. The widespread lung condition, chronic obstructive pulmonary disease (COPD), is largely preventable and treatable, affecting people of all genders globally. There are many studies estimating the burden of COPD in men and women, however, only a few studies have estimated the prevalence of COPD in women aged more than 40 years. Women are equally susceptible to COPD, as they are exposed more to domestic smoke, but they are often neglected and the disease goes unnoticed, which makes them more vulnerable to respiratory failure following a respiratory infection. To gain a comprehensive understanding, this review explores the existing research through a narrative analysis of primary research articles retrieved from PubMed. In total 15 relevant papers were extracted and reviewed. The review finds significant differences exist in the prevalence of COPD among women 40 years of age and older, with greater rates found in rural areas. Women have more severe symptoms and higher fatality rates; contributing factors to this increase are exposure to biomass fuels and growing smoking rates.

Background: Bird fancier's disease is a type of HP occurring due to exposure to bird's antigen. The diagnosis is quite difficult as it requires the identification of an inciting agent with findings of HRCT and lung biopsy. The exposure is usually done by history with antigen-specific IgG and/or specific inhalational challenge testing. The study aimed to investigate the role of pigeon allergens in house dust in bird exposure-related HP patients.

Methods: This was a descriptive, mixed-method observational study. We retrospectively screened all the files of HP patients for exposure history and pigeon-specific IgG of one-year duration. Finally, Finally house dust from 18 cases with HP was collected for analysis of concentration of pigeon droppings and feather proteins.

Results: The mean age was 47.8 ± 11.5 years with 78% being female. The median duration of symptoms was 1.75 years with a median exposure history to pigeons of 7 years. The level of specific IgG was raised in 11 (60%) patients with a mean level of 50.6 ± 39.5. The concentration of pigeon-drooping protein was present in all the dust samples with a mean of 17.6 ± 5.6 μg/mg. The highest concentration was 27 μg/mg and the lowest of 9 μg/mg. The concentration of pigeon father protein was present in nearly 50% of the dust sample with a mean of 5.6 ± 6.7 μg/mg and the highest concentration was 15.8 μg/mg.

Conclusion: The confirmation history of exposure in bird exposure-related HP is difficult because bird antigen exposure can be presents anywhere. The house dust bird protein concentration measurement is a simple, non-invasive, adjunct test for confirmation of bird exposure.