Lung India最新文献

This report highlights an exceptionally rare case of the dirofilariasis presenting with eosinophilic pleural effusion. A previously healthy 44-year-old male presented with a 1-month history of chest pain and cough. Chest computed tomography imaging revealed the right-sided pleural effusion, along with thickening of the parietal pleura. Thoracentesis was performed, yielding an eosinophilic effusion. Bronchoscopy was unremarkable, and microbiological cultures showed no significant findings. A uniporter video-assisted thoracoscopic surgery was conducted, during that a pathological lesion on the parietal pleura was identified and excised in its entirety. Histological analysis of the tissue confirmed an infection caused by the parasitic organism Dirofilaria spp. As complete surgical excision of the parasite is typically curative; no further treatment was necessary. The patient remained asymptomatic during the follow-up period. This case highlights the necessity of considering uncommon etiologist in the differential diagnosis of eosinophilic pleural effusion, especially in patients presenting with persistent or atypical clinical features.

Background: Studies in the past have demonstrated an association between sarcoidosis and pulmonary embolism (PE), but little is known about its impact, especially in young adults. We aim to determine the burden and impact of PE in young adults hospitalized with sarcoidosis.

Methods: This study investigates the prevalence and consequences of PE in young adults aged 18-44 years hospitalized with sarcoidosis using data from the National Inpatient Sample (2016-2020) with relevant International Classification of Diseases (ICD)-10 codes. This study aims to address the primary outcomes of the burden and trends of PE and its associated impact on in-hospital mortality. Additionally, it explores secondary outcomes such as healthcare resource utilization and discharge patterns.

Results: Among 50,385 young adults (median age 37 years) hospitalized with sarcoidosis, 1120 had PE, showing a linear increase from 2% in 2016 to 2.9% (P < 0.001) in 2020. The sarcoidosis-PE+ group, predominantly in young blacks, exhibited a higher prevalence of comorbidities such as obesity, smoking, drug use, peripheral vascular disease, hypothyroidism and prior history of venous thrombus embolism. In contrast, the sarcoidosis-PE- group had a higher prevalence of diabetes (with/without chronic complication), hyperlipidemia and chronic pulmonary disease. Multivariable regression analysis adjusted for all potential sociodemographic and comorbid variables showed higher odds of all-cause mortality (odds ratio [OR]: 2.92, 95% confidence interval [CI]: 1.18-7.24, P < 0.02) in the sarcoidosis-PE+ group as compared to the sarcoidosis-PE- group. The sarcoidosis-PE+ group also had higher hospital costs and length of stay.

Conclusion: The higher odds of in-hospital mortality with an increased length of stay and hospital cost observed in the sarcoidosis-PE+ group highlight the often underreported complications of sarcoidosis, particularly in a younger demographic. The relevance of this study stems from its potential to uncover trends that could lead to improved diagnostic and therapeutic strategies.

Pulmonary arterio-venous malformations (PAVMs) are abnormal vascular connections between pulmonary arteries and pulmonary veins, preventing exposure of blood to normal pulmonary capillaries, leading to shunting. We report a successfully managed case of PAVM wherein the patient presented with exertional desaturation. A 23-year-old male with no known co-morbidities presented to out-patient department with complaints of exertional breathlessness for one month. His vitals were stable but had oxygen desaturation from 98% at rest to 90% on exertion. Chest radiography demonstrated an oval homogenous opacity in the right upper zone with smooth margins. Computed Tomography Pulmonary Angiography (CTPA) demonstrated solitary PAVM located at superior segment of right lower lobe. He was successfully managed with embolization of the lesion, leading to resolution of symptoms and exertional desaturation.

Introduction: Intravenous (IV) tranexamic acid (TXA), an antifibrinolytic agent, is routinely used in the treatment of non-massive haemoptysis. Topical TXA has shown haemostatic efficacy in surgical settings and epistaxis. Limited case reports have documented successful management of pulmonary bleeding using nebulised TXA. This study was conducted to evaluate the efficacy of nebulised TXA compared to IV TXA in non-massive haemoptysis.

Materials and methods: This single-centre, randomised controlled trial included 46 adult patients with non-massive haemoptysis presenting to the Emergency Medicine department. They were randomised into two groups: IV TXA (n = 23), receiving 500 mg TXA IV 8th hourly, and nebulised TXA (n = 23), receiving 500 mg TXA via nebulisation 8th hourly. The volume of haemoptysis was recorded at presentation and at 8-hour intervals. Haemoglobin, liver, and renal function tests were recorded at admission, and haemoglobin was monitored daily. Data were analysed using appropriate statistical tests.

Results: Among the 46 patients, 30 were male. The mean age in the IV TXA group was 51.83 ± 12.58 years and 49.91 ± 13.87 years in the nebulised TXA group (P = 0.63). There were two smokers in the IV group and eight in the nebulised group. Pulmonary tuberculosis was the most common cause in both groups. The mean bleeding volume at presentation was 58.26 ± 49.69 ml (IV) and 46.96 ± 38.30 ml (nebulised) (P = 0.39). Complete cessation of haemoptysis was achieved in 7.39 ± 5.02 h (IV) and 5.70 ± 4.80 h (nebulised) (P = 0.25). Repeat doses were required in 6 (IV) and 3 (nebulised) patients (P = 0.40). No adverse effects were observed.

Conclusion: Nebulised TXA is as effective as IV TXA in managing non-massive haemoptysis.

The occurrence of two mycobacterial infections, namely tuberculosis (TB) and leprosy, in an immunocompetent person is very uncommon. This case report describes a young female who initially presented with a neck swelling diagnosed as TB. Initially treated for TB, she later developed neurological symptoms, which led to the diagnosis of leprosy. Despite beginning leprosy treatment, her symptoms persisted, requiring the administration of steroids. Discussion highlights the complex relationship between TB and leprosy, where immune responses and treatments for one disease may affect the progression of the other.

Introduction: Immune checkpoint inhibitors (ICIs) have revolutionised the treatment of advanced non-small cell lung cancer (NSCLC). Quantitative monitoring of disease burden may prove predictive in these cases. We hypothesised that serial ctDNA molecular response assessment may be predictive of response to nivolumab.

Materials and methods: 44 NSCLC patients who received nivolumab were included. All the patients underwent response assessment by RECIST every four cycles. Peripheral blood samples were obtained at baseline and after four cycles of therapy, and the quantification of ctDNA was performed by qubit dsDNA HS assay. A variant allele fraction (VAF) of >0.3% was considered to be used for tracking. A cut-off change of 50% in VAF and ctDNA was considered for molecular response. Radiological evaluations were performed at baseline and every four cycles as per RECIST 1.1 criteria.

Results: The median ctDNA concentration was higher in patients with time to progression (TTP) of <4 months (P = 0.05). Detectable alterations with >0.3% VAF were detected in 31 patients, and a molecular response of >50% was observed in patients with PR, stable disease (SD) and two patients with PD. The patients with <50%molecular response had a median PFS of 3.9 months vs. those with >50% had a median of 5.8 months (P = 0.06). A cut of 0.3 ng/microlitre baseline ctDNA concentration was predictive of PFS.

Conclusion: This is an initial experience from India using liquid biopsy next-generation sequencing (NGS) for dynamic monitoring in immunotherapy-treated patients. A 50% cut-off for response as well as a baseline ctDNA 0f 0.3 ng/microlitre showed a trend for better PFS in these patients. This study highlights the need for serial monitoring. To our knowledge, this is among the first real-world Indian studies validating serial NGS-based ctDNA monitoring in immunotherapy-treated NSCLC. It demonstrates feasibility, predictive value, and real-world applicability in a lower-middle-income context.