Lung India最新文献

Background: The burden of chronic respiratory diseases (CRDs) and their covariates have not yet been investigated in community settings of Bangladesh where the risk of the disorder is fast increasing due to adverse environmental, sociodemographic, and behavioural shifts.

Objective: In this study, the prevalence of CRDs and their socioenvironmental and behavioural risk factors have been explored in a rural Bangladeshi community.

Methods: A group of 1224 rural Bangladeshi adults, aged 34-65 years, were screened for CRDs using a locally adapted version of the International Study of Asthma and Allergies in Childhood (ISAAC) Questionnaire as well as by tools covering self-reported and/or prescription/medical record-based diagnoses of CRDs. Spirometry (by hand-held portable device) was done among CRD symptom-positive (CRDS+) subjects (n = 742), and individual CRDs [COPD, Bronchial Asthma, and Restrictive Lung Disease (RLD)] were identified following standard guidelines. Some metabolic biomarkers (OGTT, lipid profile, SGPT, and S Creatinine) were assessed among the spirometrically diagnosed CRD cases (n = 142).

Results: Based on spirometry, 19% of the non-spirometry tool-based CRD symptom-positive subjects had one or more CRDs. Higher age (P < 0.001), male gender (P < 0.001), lower BMI (P < 0.001), and exposure to cooking fuel-generated smoke (P = 0.003) were found (both on bivariate and multivariate analyses) to be the significant risk factors. The spirometry-positive CRD subjects were found to be distributed almost equally (COPD, 7%; asthma, 5%; and restrictive, 7%). COPD was found to be more common among males than females (72% vs 28%), but females showed more vulnerability to restrictive disorders (61% vs 39%). The two genders did not differ in proportions of asthma. Lower BMI was associated with COPD; on the contrary, people in higher BMI ranges suffered more from asthma and restrictive disorders. COPD was also found to be associated with tobacco smoking (P = 0.05). No significant difference among the three groups was found regarding any metabolic biomarker.

Conclusions: About one-fifth of rural Bangladeshi middle-aged people with respiratory symptoms suffer from one or more CRDs. Higher age, male gender, lower BMI, exposure to cooking fuel-generated smoke, and tobacco smoking are the major risk factors of CRDs among rural Bangladeshis with varying contributions to individual diseases.

Sarcoidosis, is a complex multisystemic disease of unknown aetiology, which manifests via a variety of symptoms frequently affecting multiple organs. Vocal cord paralysis is rarely reported with Sarcoidosis. There have been very few case report of patients presenting with vocal cord palsy due to mediastinal lymphadenopathy causing compression of recurrent laryngeal nerve. We hereby report a case series of 3 patients presenting with vocal cord palsy due to recurrent laryngeal nerve compression by enlarged mediastinal lymph nodes due to Sarcoidosis and also reviewed the supporting literature.

Background and objective: Serum periostin and carcinoembryonic antigen (CEA) are markers of type 2 inflammation. However, their role in diagnosing and monitoring treatment responses in allergic bronchopulmonary aspergillosis (ABPA) remains uncertain. The objective of the study was to assess the diagnostic performance of serum CEA and periostin in distinguishing ABPA from asthma. We also evaluate their usefulness in monitoring treatment responses.

Methods: We enrolled consecutive subjects with ABPA (cases) and asthmatic patients without ABPA (controls). Serum periostin and CEA levels were measured at baseline and again 2 months after oral prednisolone. We constructed receiver operating characteristic (ROC) curves and determined sensitivity and specificity using the optimal cut-off derived from Youden's index.

Results: We enrolled 112 and 108 subjects with ABPA and asthma (median age: 34 years) respectively. At baseline, the median serum periostin (22.03 vs 16.36 ng/mL; P < 0.001) and CEA levels (4.80 vs 2.35 ng/mL; P < 0.001) were significantly higher in the ABPA group than in the controls. CEA (AUROC = 0.77) showed better diagnostic accuracy than serum periostin (AUROC = 0.64) in differentiating asthma from ABPA. After 2 months of treatment, median serum CEA (4.8 ng/mL vs 3.7 ng/mL) and periostin levels (22.03 vs 17.74 ng/mL) declined significantly. However, 34% and 30% of subjects exhibited increased periostin and CEA levels following treatment.

Conclusion: While serum CEA and periostin exhibit modest diagnostic performance in differentiating ABPA from asthma, they are suboptimal for monitoring treatment responses. Further studies are required to validate our findings.

Pancreaticopleural fistula (PPF) is a rare (<1%) complication of acute and/or chronic pancreatitis which causes recurrent massive pleural effusions. Patient presents with respiratory symptoms rather than abdominal symptoms, which makes the diagnosis challenging and delayed. Amylase-rich pleural effusions have been reported in pancreatic diseases, oesophageal rupture, and malignant pleural effusions. Pancreatitis-related effusion including PPF should be kept in mind when a patient with chronic alcohol consumption presents with an effusion and PF amylase may aid with diagnosis. We present a case series of four young males with a history of recurrent massive pleural effusions and their varied clinical presentations, diagnostic work-up, approach and management in a rural tertiary care hospital in south India, thus contributing to literature as well emphasizing the importance of such easily available biomarkers in day-to-day practice.

Background: Tuberculosis (TB) remains a leading cause of mortality among people living with HIV (PLHIV), with delayed diagnosis contributing significantly to poor outcomes. Early detection through systematic screening and diagnostic tools is essential to reduce morbidity and mortality in this high-risk population. This study aimed to evaluate the utility of the World Health Organization (WHO) four-symptom screen (fever, cough, weight loss, and night sweats), using Xpert MTB/RIF (Cepheid, Sunnyvale, California) as the gold standard for early detection of pulmonary TB in HIV-positive patients.

Methods: A total of 249 HIV-positive patients attending a tertiary care centre in Western India were screened using the WHO four-symptom tool. All patients, regardless of symptoms, underwent testing with Xpert MTB/RIF. Sensitivity, specificity, and predictive values were calculated for the symptom screen and individual symptoms. Univariate and multivariate analysis was performed to determine significance (P < 0.05).

Results: The WHO four-symptom screen identified 40.2% of participants (n = 100) as screen-positive. Xpert MTB/RIF confirmed pulmonary TB in 5.6% (n = 14) of the total population. The combined sensitivity and specificity of the WHO symptom screen were 85.7% and 62.6%, respectively, with a high negative predictive value of 98.7%. Fever and cough were the most significant predictors (P < 0.05) in multivariate analysis.

Conclusion: The study highlights the importance of systematic TB screening among PLHIV using the WHO symptom tool in conjunction with molecular diagnostics. This approach facilitates early diagnosis and treatment, contributing to better health outcomes and aligns with global TB elimination strategies.