Thursday, September 24, 2015

Chest Radiology- A Case of Azygous Lobe

By Dr Deepu
The lungs are normally divided into five lobes by three main fissures .
 Occasionally, invaginations of the visceral pleura create accessory fissures that separate individual bronchopulmonary segments into accessory lobes .
 An azygos lobe is found in approximately 0.4% of patients . In contrast to other accessory lobes, the azygos lobe does not correspond to a distinct anatomical bronchopulmonary segment .

It forms during embryogenesis when the precursor of the azygos vein fails to migrate to its medial position in the mediastinum, where it normally arches over the origin of the right upper lobe bronchus.
 This gives rise to the following characteristics, which are visible on a standard chest x-ray

: the laterally displaced azygos vein lies between folds of parietal pleura, also referred to as the mesoazygos, where it assumes a characteristic teardrop shape ; the mesoazygos indents the right upper lobe, thereby creating the accessory (azygos) fissure, which is similar in shape to an inverted comma; the fissure delineates the azygos lobe, located superomedially ; laterally, the pleural folds of the mesoazygos separate before reaching the chest wall, resulting in a radiopaque triangular area ; and medially, the tracheobronchial angle appears empty .



 An azygos lobe may be confused with a pathological air space such as a bulla or abscess . In addition, the abnormally located azygos vein may be mistaken for a pulmonary nodule, while a consolidated azygos lobe may be confused with a mass . An understanding of the pathogenesis and characteristic x-ray features of the azygos lobe will enable an accurate diagnosis in most cases .
 If the x-ray findings are equivocal, computed tomography will be diagnostic .

Thursday, August 13, 2015

Nicotine-degrading bacteria show therapeutic promise in smoking cessation!!

An early-phase study developing a new drug to aid smoking cessation has found that an enzyme made in the lab could digest nicotine before it reaches the brain.
In the Journal of the American Chemical Society, scientists from The Scripps Research Institute (TSRI) report how the enzyme can consume nicotine, indicating the potential to significantly reduce the length of time that nicotine remains in the blood.
The team assessed a protein extracted from Pseudomonas putida bacteria in mouse models. P. putida was originally isolated from a tobacco field and is now known to rely on nicotine as its sole source of carbon and nitrogen. The team isolated the nicotine-degrading enzyme, NicA2, from the bacteria to establish whether this protein was stable and whether the process would continue once the protein was isolated.
The results showed that the protein reduced the half-life of the nicotine from one cigarette from 2–3 hours to 9–15 minutes. The team found no evidence of any negative physical or behavioural effects of the enzyme on the mice and, at this stage, the by-products from the process of breaking down the nicotine do not appear to be toxic.
The authors state that further studies are necessary, particularly with regard to any human immune-response to the protein.

Saturday, August 8, 2015

Bigger Families May Deal With More Viral Infections

HealthDay (8/7, Preidt) reports that “being part of a big family boosts the risk of passing on viral infections that cause colds, flu and other respiratory woes,” according to a study published in Clinical Infectious Diseases journal. The study of “108 people from 26 Utah families” revealed that “people in childless households were infected with viruses an average of three to four weeks a year.” Viral infections “rose to 18 weeks a year in families with one child, and up to 45 weeks a year in households with six children,” the study found.
        Meanwhile, HealthDay (8/7, Preidt) reports, “An online program that encourages people to wash their hands reduced the spread of cold and flu viruses within families,” according to a study published online in The Lancet that involved some 20,000 UK adults. The online “program also led to fewer gastrointestinal illnesses, doctor appointments and antibiotic prescriptions,” the study found.

Opposition To Larger Health Warnings Grows In India

The Deccan (IND) Herald (7/30) reports that opposition to health warnings covering 85% of tobacco packages in India has expanded from the tobacco industry to include 13 petitions from groups such as the CII (Confederation of Indian Industry) and ASSOCHAM (Associated Chambers of Commerce Of India) while no major hospitals have supported the measure. The piece notes that 26 petitions support larger warnings, however, as the Lok Sabha Committee on Subordinate Legislation prepares to issue a report on the matter to the House.

Optical Fluorescent Molecular Real-Time Imaging During Surgery May Be Used To Differentiate Lung Adenocarcinomas From Normal Lung Parenchyma

MedPage Today (8/4, Jackson) reports that research indicates that “optical fluorescent molecular real-time imaging during surgery can be used to differentiate lung adenocarcinomas from surrounding normal lung parenchyma.” The findings were published in The Journal of Thoracic and Cardiovascular Surgery.

Lung Function May Decline In Patients With Moderate To Severe COPD After Steroid Withdrawal

MedPage Today (8/5, Minerd) reports that research indicated that individuals “with moderate to severe chronic obstructive pulmonary disease (COPD) experienced significant decreases in lung function for up to 5 years after discontinuing long-term inhaled corticosteroid (ICS) treatment.” Additionally, these individuals “experienced steady worsening in airway hyperresponsiveness (AHR) and quality of life.” The findings were published in CHEST Journal.

Limited Resection May Not Be Equivalent To Lobectomy When Used To Treat Older Patients With Stage IA Lung Cancer Of Invasive Cell Types

MedPage Today (8/6, Jackson) reports that research suggests that “limited resection is not equivalent to lobectomy when used to treat older patients with stage IA lung cancer of invasive cell types, namely invasive adenocarcinoma and squamous cell carcinoma.” Rather, “these patients may be considered for completion lobectomy or for adjuvant treatments,” researchers “report online in the Journal of Clinical Oncology.”

Lung Cancer Patients May Often Experience Delays In Treatment And Miss Diagnostic Steps Before Surgery

The Houston Chronicle (8/7, Hawryluk) reports that research published in the Annals of Thoracic Surgery suggests that “lung cancer patients often experience delays in treatment and miss diagnostic steps before they proceed to surgery, which could reduce their already low chance of a cure.” Investigators “found many patients had to wait more than month to six months after an initial X-ray showed signs of possible lung cancer.” Meanwhile, just “one in 10 patients received all three of the diagnostic tests recommended before surgery.”

Thursday, August 6, 2015

Thoroughness, Accuracy Of Pre-Op Lung Cancer Evaluation Could Be Improved, Study Suggests

Cancer Therapy Advisor (8/4) reports that research suggests “for suspected lung cancer patients, the thoroughness, accuracy, and timeliness of preoperative evaluation could be improved.” The findings were published in the Annals of Thoracic Surgery.

Optical Fluorescent Molecular Real-Time Imaging During Surgery May Be Used To Differentiate Lung Adenocarcinomas From Normal Lung Parenchyma

MedPage Today (8/4, Jackson) reports that research indicates that “optical fluorescent molecular real-time imaging during surgery can be used to differentiate lung adenocarcinomas from surrounding normal lung parenchyma.” The findings were published in The Journal of Thoracic and Cardiovascular Surgery.

Lung Function May Decline In Patients With Moderate To Severe COPD After Steroid Withdrawal


MedPage Today (8/5, Minerd) reports that research indicated that individuals “with moderate to severe chronic obstructive pulmonary disease (COPD) experienced significant decreases in lung function for up to 5 years after discontinuing long-term inhaled corticosteroid (ICS) treatment.” Additionally, these individuals “experienced steady worsening in airway hyperresponsiveness (AHR) and quality of life.” The findings were published in CHEST Journal.

Tuesday, July 28, 2015

ASTHMA GUIDELINES

By Dr Deepu
BTS/SIGN Asthma Guideline 2014  BTS/SIGN British Guideline on the Management of Asthma, October 2014
Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology (January 2005)
Diagnosis and Management of Work-Related Asthma: ACCP Consensus Statement (September 2008)
Guidelines for the management of work-related asthma ERS task Force Report 2012Eur Respir J 2012; 39: 529-545

Monitoring asthma in children  ERS statement 2015 Eur Respir J 2015; 45: 906–925

COPD GUIDELINES

By Dr Deepu

An Official ATS/ERS Statement: Upper Limb Muscle Dysfunction in COPD (2014)
COPD Guideline NICE COPD Guidelines 2010
Executive Summary: Prevention of Acute Exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline (April 2015)
Prevention of Acute Exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline (April 2015)





Saturday, July 25, 2015

Thesis Topics and short term research topics.

By Dr Deepu

A clinical study to compare the efficacy, safety and plasma levels of two doses of theophylline in patients of bronchial asthma.
A clinical study to evaluate the safety and efficacy of theophylline and its modulation by ascorbic acid in patients of bronchial asthma.
A comparative evaluation of quality of life, dyspnoea, and lung function abnormalities in asthma and COPD.
A Comparative Study Of Inhaled and Intravenous Magnesium Sulphate As An Adjunct To Standard Treatment Protocol For Management Of Severe Exacerbation Of Bronchial Asthma.
A comparative study of the efficacy and safety of theophylline and doxofylline in patients of obstructive lung disease.
A prospective study comparing the outcome of chemical Pleurodesis using TALC or Tetracycline in Patients with Pneumothorax.

A study of broncho-alveolar lavage cytology in patients of rheumatoid arthritis.
A study of familial aggregation of cancer in the first degree relatives of lung cancer patients.
A study of peak-expiratory flow rate in healthy school children, 6-16 years of age.
A study of prevalence of hepatopulmonary syndrome in patients with NCPF. ATT induced hepatitis: a study on prevalence and outcome after re-introduction of drugs.
A study of prevalence of hepatopulmonary syndrome in patients with cirrhosis.
A study of serum-fluid albumin gradient in evaluation of pleural effusions.
A study of sleep-related breathing disorders in chronoc obstructive pulmonary disease patients with or eithout cor-pulmonale.
A study of species spectrum of fungi causing systemic mycoses in HIV patients in a New-Delhi Hospital and their antifungal susceptibility pattern.
A study of the measurement of quality of life of lung cancer patients.
A study of the smoking habits in patients of pulmonary tuberculosis.
A study on Pulmonary function abnormalities in patients with Carcinoma Breast following external radiation treatment.
A study to correlate the activity of ADAM33 gene protein with oxidative stress in asthma.
A study to evaluate the occurrence of metabolic syndrome in chronic obstructive pulmonary disease.
A Study to Monitor Adverse Drug Reactions in Patients of Bronchial Asthma.
A study to monitor adverse drug reactions in patients of chronic obstructive pulmonary disease.
Acute effects of tiotropium alone and in combination with formoterol in patients with COPD: comparision of three regimens.
Adenosine metabolism in bronchial asthma: a study on adenosine deaminase and 5'-nucleotidase activity and adenosine level in serum, lymphocytes and erythrocytes.
Adverse symptoms reported by patients with HIV/TB co-infection and taking both ATT and HAART
Airway obstruction, bronchial hyper-reactivity and sensitivity to commonaeroallergen in allergic rhinitis.
Airway resistance in subjects exposed to environmental tobacco smoke.
Airway response to acid application in oesophagus (simulating gastro-esophageal reflux) in patients of bronchial asthma.
Airway response to fenoterol in hypothyroid patients before and after treatment.
Airway response to provocation with methacholine aerosol in different kinds of smokers.
Alveolar haemorrhage due to pulmonary renal syndrome. A case series of 30 patients
Analysis of CT-chest of smokers with greater than 10 pack years of smoking
Antimicrobial drug prescribing pattern in hospitalised patients of community-acquired pneumonia: a retrospective study.
Arm span to height relationship for assessment of spirometric functions.
Asbestos induced changes in some cellular and molecular function in rat alveolar macrophages.
Assessment Airway response to broncho-constricting agents in leprosy.
Assessment of airway responsiveness in asymptomatic asthmatic women exposed to environmental smoke.
Assessment of health related quality of life and work productivity in school going children with allergic rhinitis and/or asthma.
Assessment of lung function in health natives of Bhutan.
Assessment of nutritional status in COPD and asthma
Assessment of radiologically guided fine needle aspiration cytology of mediastinal masses.
Assessment of severity of disease in patients with allergic rhinitis when categorized as ‘sneezers and runners’ and ‘blockers’.
Asthma and Obesity – Comparing the pulmonary function of obese and non- obese asthmatics
Biochemical Studies on Protein Kinase C In Peripheral Blood Lymphocytes Of COPD Patients.
Blood carboxyhemoglobin levels in different types of smoking.
Blood carboxyhemoglobin levels in different types of smoking.
Breath carbon monoxide levels as a marker of clinical severity and control of asthma.
Bronchial provocation with Parthenium hysterophorus pollen extract in patients of bronchial asthma.
Bronchodilator mediated airway response in health.
Cardio Pulmonary Exercise testing in asymptomatic smokers v/s Nonsmokers
Cardiorespiratory responses to exercise in patients with mild to moderate bronchial asthma.
Case series of mediastinal masses.
Characterisation of lower respiratory tract inflammation and its relationship with changes in pulmonary patho-physiology and thoracic imaging in bronchial asthma.
Commonest side effects complained by the patients initiated on HAART therapy
Comparative airway response to bronchodilators in patients of leprosy with normoreactivity and hyporeactivity to methacholine.
Comparative study of high resolution CT versus bronchography in the diagnosis of bronchiectasis.
Comparison of mometasone furoate and ciclesonide aqueous nasal spray in adult and allergic rhinitis patients.
Compliance with asthma medications. The common cause of non-adherence and predictor of compliance with recommended medications.
Correlation between morphological changes and impairment of ventilatory function in patients suffering from bronchiectesis.
Correlation of fractional exhaled nitric oxide, nasal nitric oxide with atopic status in bronchial asthma, allergic rhinitis.
Correlation of the partial pressure of arterial carbon dioxide, End-Tidal carbon dioxide and transcutaneous carbon dioxide in patients with respiratory diseases
Cough reflex threshold and diabetic autonomic neuropathy : correlation with ECG parameters of vagal involvement.
Detection, identification and profiling of mycobacterial isolates from patients of pulmonary and lymph node tuberculosis in Delhi.
Determination of maximal inspiratory and expiratory muscle pressure at mouth in healthy Indian adults.
Determination of ventilatory minute volumes required to maintain normocapnia in adult North Indian health subjects under anaesthesia.
Determination of ventilatory minute volumes, required to maintain normocapnia under anaesthesia in adult North Indian subjects.
Diabetes in chronic liver disease
Diagnostic evaluation of cholesterol and various lipoproteins in the pleural effusions.
Diagnostic Yield Of Induced Sputum And Various Bronchoscopic Samples in Sputum Smear Negative Tuberculosis.
Diaphragmatic palsies – profile of 25 consecutive patients
Diurnal variations in pulmonary function tests in normal healthy individuals.
Diurnal variations of peak expiratory flow and its correlation with different morbidity indices in bronchial asthma.
Drug interactions between rifampicin and cotrimoxazole/ aspirin in patients on antituberculosis treatment.
Drug Resistance Profiling and Molecular Typing of Mycobacterium tuberculosis Isolates from a DOTS center and a Private Hospital in Delhi.
Echocardiographic evaluation of cardiac involvement in sarcoidosis.
Echocardiographic evaluation of right and left ventricular functions in corpulmonale with chronic obstructive pulmonary disease in acute respiratory failure.
Effect of acetoxycoumarins and calcium channel blocking dihydropyrimidone derivatives on protein kinase C activity of and lymphocytes in COPD patients.
Effect of ciprofloxacin and ibuprofen on blood levels of rifampicin in patients receiving antitubercular treatment.
Effect of domestic fuels on lung functions in females.
Effect of esophageal variceal sclerotherapy on lung function.
Effect of glycemic control on outcome of acute exacerbation of COPD.
Effect of ipratropium and salbutamol on heart rate variability in chronic obstructive pulmonary disease.
Effect of irradiated lung volume on the pulmonary functions following postoperative radiotherapy in carcinoma breast.
Effect of mechanical ventilation on surfactant levels in patients with ARDS.
Effect of pulmonary rehabilitation on systemic inflammation, muscle mass and functional status in post tuberculosis sequelae.
Effect of pulmonary rehabilitation on systemic inflammation, oxidative stress and functional status in chronic obstructive and pulmonary disease.
Effect of pulmonary rehabilitation on, systemic inflammation, muscle mass and function status in interstitial lung diseases.
Empyema thoracis – Outcomes in a medical college hospital
Enalapril and bronchial responsiveness.
Endobronchial tuberculosis – presentation, diagnosis, management and complications in 30 consecutive patients
Endobronchial ultrasound vs Positron Emission tomography in the evaluation of malignant mediastinal masses
Epidemiological study and genetic diversity of PB1-F2 gene in influenza and A virus isolates from Delhi and Kolkata. Factors associated with poor asthma control and poor adherence to asthma treatment: self report by patients in emergency room.
Erythrocyte (RBC) antioxidant enzyme levels in patients with primary lung cancer.
Estimation of nitrate production by alveolar macrophages in bronchogenic carcinoma.
Evaluation of predictors of duration of mechanical ventilation.
Evaluation of pulmonary changes in patients of psoriasis on methotrexate therapy.
Evaluation of systemic inflammatory markers, oxidant-antioxidant status and sputum cytology in stages of chronic obstructive pulmonary and diseases.
Evaluation of the effect of inhaled ciclesonide on the allergic and inflammatory markers in and bronchial asthma.
Evaluation of vitamin D in asthma: its effect on inflammatory markers and impact on management.
Factors affecting attainment of control in asthma.
Factors associated with primary drug resistance in tuberculosis
Factors influencing survival time of Bronchogenic Carcinoma in a tertiary Care Centre
Foreign bodies in airways – Profile of 30 consecutive patients, interventions and outcomes
Gender differences in perception of dyspnoea, quality of life and pattern of lung function abnormalities in asthma.
Hematological abnormalities in patients with sarcoidosis.
Hepatoxicity with INH and Rifampicin.
HRCT in heavy smokers with normal chest X-ray.
Hypothalmo-pituitary-adrenocortical axis in inhaled corticosteroid users, not an oral corticosteroid: a longitudinal study.
Immunohistological studies in tubercular lymphadenitis.
Immunoregulatory effects mediated by CD4+ and gamma/delta T-cells in pulmonary tuberculosis.
Incidence of laryngeal involvement in sputum positive pulmonary TB
Incidence of TB among rheumatoid arthritis patients on TNF-alpha antagonists
Incidence of tuberculosis during corticosteroid therapy.
Indications and Outcomes of Non invasive Ventilation in a tertiary care hospital
Indices of morbidity and control of asthma in non smoking women exposed to combustion of biomass fuels.
Influence of environmental tobacco smoke exposure on acute exacerbations in known asthmatics.
Influence of environmental tobacco smoke exposure on different morbidity indices in adult asthmatic women.
Inspiratory muscle training in chronic obstructive pulmonary disease.
International guidelines for pneumococcal vaccination and the Indian scenario. Pneumococcal vaccination status of COPD patients presenting to a medical college hospital. Possible strategies to improve the vaccination coverage.
Lung abscess – presentation, predisposing factors, organisms isolated and management in 50 consecutive patients
Lung functions with relation to the fuels (biomass, LPG, kerosene and mixed) used in the houses of children in the age group of 7-15 years.
Lung volumes in healthy non smoking adults belonging to ethnic Punjabi population by CT volumetry
Measurement of bronchial hyperreactivity in patients with idiopathic pulmonary fibrosis.
Mediastinal pathologies – 50 consecutive cases in a tertiary care hospital
Narrow band Imaging guided bronchial biopsy vs white light bronchoscopy guided bronchial biopsy
Nebulized salbutamol for acute hyperkalemia in renal failure patients.
Neutrophil count and myeloperoxidase activity in smokers.
Neutrophil superoxide (free radical) levels and total neutrophil count in peripheral blood of smokers (asymptomatic and symptomatic with chronic obstructive pulmonary disease) of cigarette, bidi, hookah and mixed product. Vitamin A, beta-carotene and vitamin C in patients of lung cancer.
Nifedipine in bronchial asthma.
Non-invasive evaluation of cardiac abnormalities in rheumatoid arthritis.
Obstructive sleep apnoea, oxidative stress and liver function.
Obstructive sleep apnoea, oxidative stress and renal function.
Occurrence of nasobronchial hypersensitivity in patients having contact dermatitis to Parthenium hysterophorus.
Occurrence of upper airway symptoms and their impact on quality of life (QoL) in patients with COPD.
Oxygen free radicals: their role in mycobacterial killing and the mechanism of action.
Pattern of respiratory diseases and associated co-morbidities in patients attending Vallabhbhai Patel Chest Institute.
Percentage of HIV seropositivity in smear positive tuberculosis patients in a medical college hospital in western india
Phenotypic and molecular characterisation of clinical isolates of Acinetobacter spp.
Phenotypic and molecular characterisation of clinical isolates of Candida species with special reference to Candida dubliniensis.
Post bronchodilator reversibility in COPD and its correlation with the stage of COPD as per GOLD guidelines and BODE score
Post op pulmonary complications in patient undergoing liver transplant surgery
Prediction of blood carboxy-haemoglobin from expired air carbon monoxide samples in "bidi" and cigarette smokers.
Prediction of pulmonary function for lung resection.
Predictors Of Emergency Department Use In Asthmatics.
Predictors of Oxygen derived - free radicals in non smoker women exposed to environmental tobacco smoke.
Pre-op spirometry and post op pulmonary complications in patients undergoing elective upper abdominal surgeries.
Presence of pulsus paradoxus in a population of severe COPD as assessed by pulse oximetry.
Prevalence of components of Metabolic Syndrome in pregnant women with obstructive sleep apnoea / hypopnoea Syndrome.
Prevalence of obstructive sleep apnea in patients admitted for bariatric surgery
Production of anti-oxidant enzymes by pulmonary alveolar macrophages in patients with lung cancer.
Production of oxygen derived free radicals by peripheral blood polymorphonuclear leukocytes in different stages of Asthma in adults.
Production of oxygen free radicals by pulmonary alveolar macrophages in patients with lung cancer.
Production of reactive nitrogen intermediates and L-cirtrulline by peripheral blood polymorphonuclear leukocytes in bronchial asthma.
Profile of 50 consequent interstitial lung disease patient attending tertiary care center.
Profile of hospital acquired pneumonia over a one year period in a tertiary care hospital. The predisposing factors, organisms isolated, antibiotics used and outcomes.
Profile of method and criteria used for weaning from mechanical ventilation in Respiratory Critical Care Unit.
Pulmonary function changes after large volume paracentesis in patients with cirrhosis of liver and ascites.
Pulmonary function in patients of idiopathic ulcerative colitis.
Pulmonary function tests before and after transhiatal oesophagectomy for carcinoma oesophagus.
Pulmonary hypertension in patients diagnosed with severe obstructive sleep apnea.
Pulmonary insufficiency after skeletal trauma.
Quantification of cells recovered by bronchoalveolar lavage in pulmonary tuberculosis.
Radiologic evaluation of total lung capacity.
Rapid molecular typing and Th1-Th2 cytokine profiling in patients suffering from tubercular lymphadenopathy.
Reference values for Maximum Voluntary Ventilation for the Indian adults.
Relative contribution of the parasympathetic and sympathetic mechanisms in airway obstruction in bronchial asthma.
Respiratory complications in 50 HIV seropositive patients followed over a period of one year
Respiratory symptoms among the farmers.
Retrospective study of road traffic accidents in patients diagnosed with severe obstructive sleep apnea
Reversibility of FEV1 and FEV in COPD post bronchodilation and its correlation with COPD stages.
Role of atopy in the etiology of non-smoker chronic bronchitis.
Role of bronchoscopy in smear negative pulmonary tuberculosis.
Role of cardiopulmonary exercise testing (C-PET) in pre op evaluation
Role of domestic fuels on the course of bronchial asthma in nonsmoking women.
Role of epithelium in the airway responses to hyperosmotic solutions in normal and sensitised guinea pigs
Role of HRCT in management of pulmonary infections in renal transplant recipients.
Role of NIV in severe type 2 respiratory failure. Predictors of success and failure with NIV use.
Role of Omalizumab in the management of asthma. Outcomes in 20 patients who were administered omalizumab
Role of some inflammatory markers in obstructive sleep apnoea: effects of grape seed extract.
Role of TLR expression in innate activity during virus infection in acute asthma.
Sensitisation with selected fungi in patients of asthma and chronic obstructive pulmonary disease and its correlation with skin prick testing and clinical presentation.
Sensitivity and specificity of tuberculin skin test for the diagnosis of pulmonary tuberculosis in patients seeking treatment for respiratory problems.
Serodiagnosis of tuberculosis in adults using ELISAS test with antigen - 5.
Significance of the reactive nitrogen intermediates in the pathophysiology of human pulmonary tuberculosis.
Skin hypersensitivity and precipitating antibodies against Aspergillus fumigatus in patients of bronchial asthma.
Socio-demographic profile and B.M.I. characteristic of patients with pulmonary tuberculosis attending chest clinic.
Socioeconomic class and compliance with asthma medications
Spectrum and outcome of acute lung injury in Respiratory Critical Care Unit.
Spectrum of changes in computed tomography in chest in pulmonary tuberculosis.
Spirometry in athletes versus normal individuals of same height
Status of reactive oxygen species and antioxidant defense system in alveolar macrophages of lung cancer patients.
Status of reactive oxygen species and anti-oxidant defense system in alveolar macrophages and peripheral blood neutrophils of lung cancer patients.
Studies on the role of lipids of lipid raft of erythrocyte membrane in COPD patients.
Studies on T-Lymphocytes in tubercular pleural effusion.
Study of carcinoembryonic antigen and sialic acid levels (total and lipid bound) in patients with lung cancer.
Study of cardiac autonomic dysfunction.
Study of cellular composition of bronchoalveolar lavage fluid in patients with pulmonary tuberculosis using flow-cytometry.
Study of effects of 6 months' therapy with methotrexate on pulmonary functions in patients of rheumatoid arthritis.
Study of non-specific airway responsiveness in patients of rheumatoid arthritis.
Study of relationship of endobronchial and transbronchial lung lesions in patients with clinical diagnosis of sarcoidosis.
Study of respiratory tract involvement in leprosy.
Study of sinonasal involvement in patients of interstitial lung diseases.
Study of the occurrence and mechanisms of programmes cell death (apoptosis) in peripheral blood mononuclear cells of pulmonary tuberculosis patients.
Success rate of nicotine patch is a hospital based smoking cessation program
Surfactant protein-A and nitric oxide derivatives in lung lavage obtained from patients with idiopathic pulmonary fibrosis.
Suspicious nodules in asymptomatic smokers with greater than 30 pack years of smoking by low dose CT screening
The clinical, Radiological and function profile in diffuse Parenchymal Lung Disease.
The effect of socioeconomic upbringing on the lung function
The impact of smoking on treatment outcome in patients of bronchial asthma.
The incidence of cavities in 5000 chest x rays taken in a medical college hospital. (Mass miniature radiography was used to detect TB earlier)
The incidence of HIV in patients admitted for elective surgery.
The occurrence of rhinosinusitis in patients with bronchial asthma and/or allergic rhinitis.
The usefulness of bronchoscopic brush specimen versus biopsy in the diagnosis of carcinoma of lung
The usefulness of Heliox in acute severe asthma
Thyroid function in smokers.
To compare the inflammatory mediator profiles, pulmonary function tests and skin and reactivity in obese and non-obese bronchial asthma patients.
To determine the occurrence and effect of nasal polyps in patients with bronchial asthma and / or allergic rhinitis.
To test the reliability of a Hindi questionnaire designed and validated for diagnosis of asthma for prevalence studies.
Transbronchial lung biopsy in sarcoidosis and relationship of histological changes with pulmonary function tests.
Tuberculin sensitivity in patients with pulmonary sarcoidosis.
Tuberculin sensitivity in patients with sarcoidosis. Predicting outcome in respiratory intensive care: comparative evaluation of three severity scoring systems.
Use of inhaled steroids and Inhaler technique among asthmatics admitted with acute exacerbation.
Validity of new study questionnaire in Hindi for diagnosis of asthma for epidemiological studies.

Visual analogue scales in assessing severity of bronchial asthma.

Saturday, July 18, 2015

Recent 2015 IPF Guidelines Update Adds New Agents.

I have written this post giving an overview of  the latest IPF guidelines.The update to the 2011 guidelines appeared in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine. At the end I have provided download links for the article and supplements.

  Pirfenidone  and Nintedanib were recommended for use in idiopathic pulmonary fibrosis (IPF) with a moderate level of confidence, in a guideline update from 
ATS/ERS/JRS/ALAT
      It also mentions that the methods used by guideline panels to appraise the evidence are different than those used by regulatory agencies like FDA when they review applications seeking market approval for the use of pharmacologic agents for treatment of IPF.


The guidline doesnot provide recommendations for one treatment regimen over another.  The guideline does not provide suggestions for or against combination regimens or sequential therapies.
     
The updated guidline has given strong recommendation against using prednisone with azathioprine and N-acetylcysteine,The update also included strong recommendations against use of warfarin or other anticoagulants due to signals for harm in randomized trials in both cases. Both previously had been suggested as not appropriate for most patients but perhaps reasonable for some.
   
 Imatinib and ambrisentan, not previously addressed in the guidelines, got strong recommendations against use in IPF patients. Sildenafil is included in the guidelines, and got a conditional recommendation against use.

     The guidelines also updates on the dual endothelin receptor antagonists macitentan and bosentan , it has changed from a strong to a conditional recommendation against use.

   The Lung transplantation which was not addressed in 2011 was also included but formulation of recommendation for single vs bilateral lung transplantation was deffered.

   There is no change in the recommendation for anatacid therapy and N acetyl cysteine monotherapy which remains as conditional recommendation for use and conditional recommendation against use respectively.

     Adverse effects were common with nintedanib therapy, particularly diarrhea, although serious adverse events were not increased and relatively few patients discontinued the drug due to adverse effects. 
      Pooled results from the pirfenidone trials showed more risk of photosensitivity, fatigue, stomach discomfort, and anorexia with the drug.

 I have given the links to Download article from ATS.. Happy reading :)

1.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/executive_summary.pdf
2.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement.pdf
3.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement+2.pdf

Easy Way To Interpret Chest X Ray

   Chest X-Rays (CXR) are routine investigation in clinical practice and consequently it is important for medical students and clinician’s alike to know how to interpret them. There are many approaches to CXR interpretation, each trying to ensure that key abnormalities are identified and no area is overlooked.
Many people would be familiar with the ABC method to interpreting CXRs.
  • Airways
  • Breathing & Bones
  • Circulation
This is a simple way of approaching CXR, and it works for many people, however some people still struggle using this approach. 

IMPROVE YOUR X RAY READING SKILLS, BUY A BOOK

Normal CXR Labelled
DRSABCD is a familiar acronym for those who have undertaken First Aid/Basic Life Support courses. NowDRSABCDE can used as a simple, yet comprehensive, approach to CXR interpretation.

D – Details

Before you even begin interpreting a CXR you should have the correct details. This includes;
  • Patient name, age / DOB, sex
  • Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series
  • Date and time of study

R – RIPE (assessing the image quality)

Next up, how “ripe” is the image. That is, what is the technical quality of the film?
  • Rotation – medial clavicle ends equidistant from spinous process
  • Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded?
  • Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane)
  • Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow.

S – Soft tissues and bones

In CXR interpretation it is common to leave soft tissues until the end.
  • Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density
  • Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses
  • Breast shadows
  • Calcification – great vessels, carotids

A – Airway & mediastinum

  • Trachea – central or slightly to right lung as crosses aortic arch
  • Paratracheal/mediastinal masses or adenopathy
  • Carina & RMB/LMB
  • Mediastinal width <8cm on PA film
  • Aortic knob
  • Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum.
  • Check vessels, calcification.

B – Breathing

  • Lung fields
    • Vascularity – to ~2cm of pleural surface (~3cm in apices), vessels in bases > apices
    • Pneumothorax – don’t forget apices
    • Lung field outlines – abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae
    • Horizontal fissure on Right Lung
    • Pulmonary infiltrates – interstitial vs alveolar pattern
    • Coin lesions
    • Cavitary lesions
  • Pleura
    • Pleural reflections
    • Pleural thickening

C – Circulation

  • Heart position –⅔ to left, ⅓ to right
  • Heart size – measure cardiothoracic ratio on PA film (normal <0.5)
  • Heart borders – R) border is R) atrium, L) border is L) ventricle & atrium
  • Heart shape
  • Aortic stripe

D – Diaphragm

  • Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space)
  • Diaphragm shape/contour
  • Cardiophrenic and costophrenic angles – clear and sharp
  • Gastric bubble / colonic air
  • Subdiaphragmatic air (pneumoperitoneum)

E – Extras

  • ETT, CVP line, NG tube, PA catheters, ECG electrodes, PICC line, chest tube
  • PPM, AIDC, metalwork