Lung India最新文献

Pulmonary hamartomas are the most common benign tumours of the lung and are often detected incidentally. Endobronchial hamartomas, though rare, can cause significant symptoms such as dyspnoea, haemoptysis, and recurrent respiratory infections due to bronchial obstruction. This report describes the successful bronchoscopic management of symptomatic endobronchial hamartomas in two young Indian males aged 29 and 34 years. Both cases were diagnosed based on radiological and histopathological findings. The first patient underwent eight sessions of electrocautery fulguration using a flexible bronchoscope, while the second was treated with six sessions of cryotherapy delivered through a flexible bronchoscope guided cryoprobe. All procedures were carried out under conscious sedation via nasal insertion of the flexible bronchoscope, with no requirement for rigid bronchoscopy or general anaesthesia. Both patients showed marked symptomatic improvement and near-complete resolution of endobronchial lesions. Follow-up bronchoscopies at 18 and 12 months, respectively, revealed no recurrence, and no procedure-related complications were observed. These cases highlight the safety, efficacy, and minimally invasive nature of flexible bronchoscopic techniques such as electrocautery and cryoablation in managing endobronchial hamartomas, particularly in settings where surgical options may be limited.

Introduction: The increased risk of tuberculosis associated with inhalation corticosteroids has been demonstrated in various studies. However, the specific risk factors for developing tuberculosis in this context are less studied. So, this study was planned.

Methods: This cross-sectional study was carried out in the Department of Pulmonary Medicine of a tertiary care centre in Puducherry, India. Those patients who were on inhalational corticosteroid for more than 1 year and having presumptive TB symptom were included in the study. Sputum smears, chest radiography, and CBNAAT were done in all cases of presumptive tb cases, and bronchoscopies and BAL where necessary were used to diagnose patients. The patient was diagnosed with tuberculosis diagnosis upon microbiologic confirmation.

Results: 1550 patients had symptoms of presumptive tuberculosis and were thus included in the study. The mean age of our study population was 50.97 ± 19.25. Male gender, use of higher doses of steroids, coronary artery disease, smoking, and alcohol use were the risk factors for the development of tuberculosis. On multivariate regression analysis, diabetes (OR: 6.4, 95% CI: 2.275-18.121, P value: 0.001) and higher doses of steroid use (OR: 7, 95% CI: 2.485-20.026, P value: 0.001) were identified as independent risk factors for the development of tuberculosis among patients using inhalational corticosteroids. The number indeed to screen was 262.

Conclusion: Patients who were on higher doses of inhalational corticosteroids and diabetic patients should be advised to undergo targeted screening and testing for tuberculosis. In order to get one case tuberculosis patient, we have to screen 262 cases of OAD patients.

Thoracic ultrasonography (TUS) is a long-established imaging modality with proven efficacy and reliability in the diagnosis of numerous pleuro-parenchymal diseases. Lung abscess (LA) is an infectious disease characterized by liquefactive necrosis and cavitation within the pulmonary parenchyma, typically occurring in immunosuppressed patients or those with various risk factors. Its treatment involves effective antibiotic therapy and, in rare cases, drainage or surgery. Obtaining a sample from the LA, when feasible, is crucial for initiating targeted therapy based on the pathogen identified in the culture. In this case report, we present a 44-year-old female patient hospitalized for an LA. The abscess was visualized via TUS, sampled under ultrasound guidance and successfully managed with ongoing ultrasonographic monitoring.

Background and objective: Cardiac comorbidity is an important prognostic factor in chronic lung diseases. The presence of pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) is associated with higher morbidity and mortality, with an increased risk of exacerbations, compared with COPD patients without PH.

Methods: One hundred and twenty patients with COPD and sex and age-matched 120 non-COPD patients were enrolled. A mean right descending pulmonary artery diameter (RDPAD) on chest radiographs (CXR), mean pulmonary arterial pressure (mPAP) on echocardiograms, and lung function on Spirometry were evaluated. Student t-test, Chi-square, and ANOVA were used to test these two groups' differences to determine PH. The Spearman correlation coefficient assessed the linear relationship between the mPAP and RDPAD, and the statistical significance was P < 0.05.

Results: The subjects' mean RDPAD was higher than the controls, 15.48 ± 1.64 mm vs. 14.23 ± 1.44 mm (P value < 0.001), and higher in men than in women. The subjects' mean RDPAD significantly increased with the severity of COPD (P = 0.007) and increasing body mass index (BMI) (P = 0.032). The subjects' median mPAP was higher than the controls (U = -5.490, P < 0.001), with higher values in the women. A significant correlation was found between the RDPAD on CXR and the mPAP from echocardiograms (r = 0.263, P < 0.001), with a PH prediction accuracy of 81%.

Conclusion: The study demonstrated that RDPAD on the CXR significantly correlates with echocardiography-estimated mPAP, and they are diagnostic tools good enough to predict PH in COPD patients.

Background and objective: This study evaluates the treatment outcomes and adverse drug reactions (ADRs) of longer oral bedaquiline (BDQ)-based (without delamanid) antitubercular therapy (ATT) regimens in children aged 5-18 years.

Methods: A retrospective study was conducted between June 2021 and February 2024. We included 105 children diagnosed with drug-resistant tuberculosis (DR-TB) and treated with longer oral BDQ-based regimens. Duration of treatment was based on clinico-radiological resolution and multiple ADRs. Data on demographics, clinical features, resistance patterns, treatment regimens, outcomes, and adverse effects were analyzed.

Results: Mean age was 11.29 ± 3.20 years, with a male-to-female ratio of 0.42:1. Prior ATT exposure was reported in 61 (58.1%), with previous treatment failure in 34 (55.7% of those with prior exposure) patients. BDQ was administered for a median duration of 6 months, with 14 (13.33%) requiring extension. BMLCC (bedaquiline-moxifloxacin-linezolid-cycloserine-clofazimine) regimen was received by 61 (58.1%), and BLCC ± additional drugs (bedaquiline-linezolid-clofazimine-cycloserine) regimen was received by 30 (28.6%) patients. Treatment completion was achieved in 75 (71.43%) patients with a mean duration of 22.50 ± 7.50 months, of which 35 (46.67%) required treatment for 18 months, 32 (42.67%) required treatment for more than 18 months, and 8 (10.67%) patients required treatment stoppage before 18 months in view of multiple ADRs. Fifty-one (48.6%) patients had ADRs, including QTc prolongation in 25 (23.8%), psychosis 11 (10.5%), and vomiting 7 (6.7%).

Conclusion: BDQ-based regimens are effective in treating pediatric DR-TB, with high treatment completion rates. However, the duration of treatment is 18 months or longer in most patients based on clinico-radiological resolution. ADRs, particularly QTcF prolongation, warrant close monitoring and follow-up.

Background: Polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea syndrome (OSAS), but identifying clinical markers can aid early detection. Tongue scalloping (TS) indicates upper airway obstruction, but its diagnostic significance in OSAS requires further exploration. The present study was to assess the prevalence of TS in individuals with obesity and high-risk features of sleep-disordered breathing and to evaluate its correlation with polysomnographic parameters compared to snoring and daytime somnolence.

Methods: This observational cross-sectional study included 1261 participants, of whom 250 were diagnosed with OSAS via PSG. Demographic, clinical, and polysomnographic data were analyzed to compare OSAS and non-OSAS groups, as well as OSAS patients with and without TS. Diagnostic accuracy measures, including sensitivity, specificity, and predictive values, were calculated for TS, snoring, and daytime somnolence.

Results: OSAS patients were significantly older and had a higher prevalence of snoring, smoking, and daytime somnolence. TS was observed in 39.6% of OSAS patients compared to 20.5% of non-OSA participants (P < 0.001). TS exhibited moderate specificity (79.5%) and a high negative predictive value (84.2%) for OSAS diagnosis. It showed the highest specificity for nocturnal desaturation (84%) and had a high positive predictive value (90%). Logistic regression identified smoking, TS, snoring, daytime somnolence, higher neck circumference, body mass index, and waist-to-height ratio as independent OSAS predictors.

Conclusion: TS is a valuable clinical marker for OSAS, particularly in high-risk individuals. Combined with established clinical features, it can enhance non-invasive screening and aid in early detection and diagnosis.