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Background/Objectives: Radiography is an essential and low-cost diagnostic method in pulmonary medicine that is used for the early detection and monitoring of lung diseases. An adequate and consistent image quality (IQ) is crucial to ensure accurate diagnosis and effective patient management. This pilot study evaluates the feasibility and effectiveness of the International Atomic Energy Agency (IAEA)'s remote and automated quality control (QC) methodology, which has been tested in multiple imaging centers. Methods: The data, collected between April and December 2022, included 47 longitudinal data sets from 22 digital radiographic units. Participants submitted metadata on the radiography setup, exposure parameters, and imaging modes. The database comprised 968 exposures, each representing multiple image quality parameters and metadata of image acquisition parameters. Python scripts were developed to collate, analyze, and visualize image quality data. Results: The pilot survey identified several critical issues affecting the future implementation of the IAEA method, as follows: (1) difficulty in accessing raw images due to manufacturer restrictions, (2) variability in IQ parameters even among identical X-ray systems and image acquisitions, (3) inconsistencies in phantom construction affecting IQ values, (4) vendor-dependent DICOM tag reporting, and (5) large variability in SNR values compared to other IQ metrics, making SNR less reliable for image quality assessment. Conclusions: Cross-comparisons among radiography systems must be taken with cautious because of the dependence on phantom construction and acquisition mode variations. Awareness of these factors will generate reliable and standardized quality control programs, which are crucial for accurate and fair evaluations, especially in high-frequency chest imaging. [ABSTRACT FROM AUTHOR]

Summary of Key Points: Eligibility criteria for lung cancer screening increasingly need to consider family history of lung cancer, as well as age and smoking status.Lung cancer screening will reveal a multitude of incidental findings, of variable clinical significance, and with a need for clear pathways of management.Pulmonary nodule sampling is enhanced by intra‐procedural imaging and cutting‐edge robotic technology.Systematic thoracic lymph node sampling has implications for treatment efficacy.Bronchoscopic ablative techniques are feasible for peripheral lung cancers.Bronchoscopic sampling continues to have a high yield for lung cancer molecular characterization.Immunotherapy indications have expanded to include early stage and resectable lung cancer. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of peripheral pulmonary lesions (PPL) is still challenging. We describe a novel method for sampling PPL without bronchial signs by creating invisible tunnel under electromagnetic navigation without the transbronchial access tool (TABT). Methods: During electromagnetic navigation, we adjust the angle of the edge extended working channel catheter based on the real-time position of the lesion in relation to the locating guide rather than preset route. A biopsy brush or biopsy forceps is used to punch a hole in the bronchial wall. A locating guide is then re-inserted to real-time navigate through the lung parenchyma to the lesion. Safety and feasibility of this method was analyzed. Results: A total of 32 patients who underwent electromagnetic navigation bronchoscopy were retrieved. The mean size of the lesion is 23.1 mm. The mean operative time of all patients was 12.4 min. Ten of the patients did not have a direct airway to the lesion, thus creating an invisible tunnel. For them, the length of the tunnel from the bronchial wall POE to the lesion was 11–30 mm, with a mean length of 16.9 mm and a mean operation time of 14.1 min. Adequate samples were obtained from 32 patients (100%), and the diagnostic yield was 87.5% (28/32). Diagnostic yield of with create the invisible tunnel TBAT was 90% (9/10), and one patient undergone pneumothorax after operation. Conclusions: This method is feasible and safe as a novel approach sampling pulmonary lesions without bronchial signs, and it further improves current tunnel technique. [ABSTRACT FROM AUTHOR]

The document titled "Correction to 26th Congress of the Asian Pacific Society of Respirology Above and Beyond, 17–20 November 2022, Seoul" in Respirology has updated the abstract authors' byline and affiliation for the abstract "Demographic and clinical characteristics of patients with severe asthma in the Asian Pacific region." The correction includes a list of authors and their respective affiliations from various institutions across different countries. The update addresses an error in the original publication and provides accurate information for research purposes. [Extracted from the article]

Summary: Despite advances in clinical decision support, the diagnosis, prognostic risk stratification, treatment and disposition of emergency department patients with pulmonary embolism remain challenging. The use of diagnostic risk stratification tools and D‐dimer can decrease unnecessary exposure to radiation and intravenous contrast; however, D‐dimer is elevated in many conditions including normal pregnancy, so imaging is often indicated. Once diagnosed, prognostic risk stratification tools can inform treatment decisions across the risk spectrum, including identifying low‐risk patients with pulmonary embolism who can safely be treated at home. For patients requiring hospitalization, alternatives to unfractionated heparin can improve time to therapeutic anticoagulation and reduce treatment‐related bleeding risk. [ABSTRACT FROM AUTHOR]

Introduction Respiratory diseases constitute a major cause of morbidity and mortality worldwide. The objective of our study was to identify the causes and factors associated with the death of patients in the Pulmonology Department of the Treichville University Hospital. Patients and methods This was a retrospective cross-sectional study analyzing patients who died while hospitalized in the Pneumology Department of Treichville University Hospital between April 2019 and April 2020. Results The study covered 514 files, including 177 deaths, representing an overall mortality of 34.4%. There were 109 men and 68 women with an average age of 45.20 years. The main antecedents were HIV infection (42.18%) and tuberculosis (38.1%). The main causes of death were pulmonary tuberculosis (49.69%), pneumocystosis (20.75%), and bacterial pneumonia (18.87%). Severe anemia (53.68%) and severe renal failure (19.85%) were the biological abnormalities associated with pulmonary pathologies. In univariate analysis, the factors associated with deaths were age less than 25 years, HIV seropositivity, nonmedical access to the service, self-medication, the presence of signs of initial clinical and radiological severity, a diagnosis of tuberculosis and neoplastic pathology, also the existence of difficulties during hospitalization. Multivariate analysis revealed HIV infection [odds ratio (OR)=1.46, confidence interval (CI)=0.27–0.77, P=0.003], diagnosed pulmonary tuberculosis (OR=1.51, CI=0.30–0.87, P=0.01), the presence of signs of clinical severity (OR=1.20, CI=0.09–0.42, P=0.00) and initial radiological severity (OR=1.27, CI=0.11–0.64, P=0.003) and the presence of difficulties during hospitalization (OR=1.16, CI=0.05–0.54, P=0.003). Conclusion Mortality remains high in pulmonology hospitalizations. Currently, tuberculosis and HIV infection are the main causes of death. Efforts to combat these two conditions must be strengthened by taking into account these factors associated with deaths.

Objective: This study aims to analyze the efficacy of pulmonary rehabilitation on exercise capacity, lung function, and quality of life (QoL) in advanced lung cancer. Method: This Systematic Review and meta-analysis were conducted based on Randomized Clinical Trials and Prospective articles obtained through searches in PubMed, Google Scholar, Europe PMC, and Cochrane Library. The review focuses on the predetermined topic. The quality of the study was assessed by the Jadad scale for clinical trial studies and Newcastle Ottawa Scale for Cohort. Statistical analysis was done using Review Manager 5.4 software. Result: A total of 6 RCT studies with 251 participants were included in this meta‐analysis. Patients with lung cancer who have received chemotherapy and or radiation therapy and undergo pulmonary rehabilitation programs have a significant impact on exercise capacity The Six Minute Walk Test (MD=72.06 [95% CI 25.45, 118.67], p=0.002), Forced Expiratory Volume (MD=13.03 [95% CI 0.18,25.89], p= 0.05), Forced Vital Capacity (MD=12.44 [95% CI 0.58, 24.30], p= 0.04) dan HRQoL Functional Assessment of Cancer Therapy-Lung Cancer Subscale (MD=1.64 [95% CI 0.07,3.21], p= 0.04). Conclusion: Our study suggests that pulmonary rehabilitation impact exercise capacity (6MWT), improvement in lung function, and quality of life. Keywords: Lung cancer; Pulmonary Rehabilitation; Chemotherapy; Radiotherapy

AIM: The aim of the study was to assess adherence to asthma controller therapy and factors that influence asthma control and to determine the association between asthma knowledge of the caregiver and asthma control among admitted children with asthma. SETTINGS AND DESIGN: A cross-sectional study was conducted between November 2022 and May 2023 in a tertiary care hospital. Children with a diagnosis of asthma aged 2–14 years, who were admitted to the hospital with an exacerbation of asthma were identified. METHODS: Caregivers of the admitted children were interviewed using the Asthma Knowledge Questionnaire and Pediatric Inhaler Adherence Questionnaire. STATISTICAL ANALYSIS USED: Demographic and clinical data were described using descriptive analyses, where mean and standard deviation were used for normally distributed continuous variables, median and interquartile range (IQR), if otherwise. A P < 0.05 was set as a cutoff for statistical significance. RESULTS: A total of 144 caregivers completed the survey. Median score for parents’ knowledge of asthma was 64%, with an IQR of 59–67. Both mother’s and father’s educational levels were associated with a good level of knowledge: odds ratio (OR) = 2.48, 95% confidence interval (CI) = 1.1–5.6, and OR = 5.33, 95% CI = 2.23–12.7, respectively. Median adherence to metered dose inhaler (MDI) was 4 (IQR = 2–6). Children who had been admitted to the general ward in the last 6 months were three times more likely to be nonadherent to MDI (OR = 3.03, 95% CI = 1.18–7.82). Forty-three percent of children who were nonadherent to MDI were less likely to have their asthma controlled (OR = 0.43, 95% CI = 0.17–1.06). CONCLUSION: This study revealed that a low level of knowledge among caregivers of asthma patients is linked to inadequate adherence to asthma controller therapy. As medication adherence is crucial for achieving desirable asthma control and improving the quality of life for this population, efforts need to be made to enhance the knowledge level of parents of children with asthma.

Nader Ahmed Mohammed,1 Abdulrahman OE Adam,2 Monzir Ahmed Hassan Osman,2,3 Hibatallah MA Abass,2,3 Awad MA Salih,2,3 Ameer AM Abaker,2,3 Alamin Mustafa,3,4 Mamoun Magoub5 1Department of Medicine, Faculty of Medicine, University of Kassala, Kassala, Sudan; 2Faculty of Medicine, Omdurman Islamic University, Omdurman, Sudan; 3Patient Support Organization Research Unit, Khartoum, Sudan; 4Faculty of Medicine, Al-Neelain University, Khartoum, Sudan; 5Department of Microbiology & Parasitology, Faculty of Medicine & Health Science, West Bank of Gash River, University of Kassala, Kassala, SudanCorrespondence: Mamoun Magoub, Department of Microbiology & Parasitology, Faculty of Medicine & Health Science, West Bank of Gash River, University of Kassala, Kassala, Sudan, Tel +24991291999, Email mamounmagzoub@kassalauni.edu.sd Alamin Mustafa, Faculty of Medicine, Al-Neelain University, JG37+2RM, 52nd St, Khartoum, Sudan, Tel +249902612984, Email alamin900005@gmail.comBackground: Ascaris lumbricoides is a common infectious parasite of the gastrointestinal tract worldwide, but the invasion of the pleural cavity is rare.Case Report: A 45-year-old man from Eastern Sudan presented to the emergency department complaining of breathlessness, cough stained with blood, and chest pain one month before his presentation. Also, he complained of high-grade fever for two weeks associated with sweating. Diagnosis of hydropneumothorax was made and a chest tube was inserted, two days later we found three adult A. lumbricoides worms in the chest drain.Conclusion: The patient was treated with Albendazole 200 mg, orally twice, daily for seven days, he improved and was referred to a cardiothoracic surgeon for more assessment. Our study highlights that internal medicine specialists should know about pleural ascariasis when patients present with respiratory signs and symptoms, especially in A. lumbricoides endemic regions like Eastern Sudan.Keywords: neglectable tropical diseases, pulmonology, pleural cavity, ascariasis, Ascaris lumbricoides

Abstract Background Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with autoimmune systemic inflammation. The evidence on the role of C-reactive protein (-CRP) in predicting mortality among people with COPD remains mixed. Methods Data from the National Health and Nutrition Examination Survey (1999–2010) were linked with mortality files up to December 31st, 2019, from the National Death Index. Adults ages 20 years or older were included in the analytic sample to assess the relationship between physician-diagnosed self-reported COPD and mortality based on blood CRP levels. Multivariate complex samples Cox regression analyses were conducted to determine the hazards ratios (with 95% CI). Results A total of 30,669 individuals comprised of the final sample with 2215 deaths observed upon follow-up for an average of 10.2 years. Compared to individuals without COPD or elevated CRP, individuals with COPD but without elevated CRP (HR = 1.25, 95% CI = 0.97–1.61) did not have a significantly higher risk of mortality. However, those with both COPD and elevated CRP had a significantly higher risk of mortality (HR = 2.70, 95% CI = 1.08–6.81). Age, health insurance status, and a history of comorbidities modified these relationships. Conclusions Biomarkers such as CRP continue to show promise for long-term COPD-related outcomes. Additional prospective assessments of individuals with airway obstruction are warranted to understand if CRP levels predict the occurrence or worsening of COPD and if those relate to long-term health outcomes.

BACKGROUNDLower respiratory tract infection (LRTI) is a leading cause of death in children worldwide. LRTI diagnosis is challenging because noninfectious respiratory illnesses appear clinically similar and because existing microbiologic tests are often falsely negative or detect incidentally carried microbes, resulting in antimicrobial overuse and adverse outcomes. Lower airway metagenomics has the potential to detect host and microbial signatures of LRTI. Whether it can be applied at scale and in a pediatric population to enable improved diagnosis and treatment remains unclear.METHODSWe used tracheal aspirate RNA-Seq to profile host gene expression and respiratory microbiota in 261 children with acute respiratory failure. We developed a gene expression classifier for LRTI by training on patients with an established diagnosis of LRTI (n = 117) or of noninfectious respiratory failure (n = 50). We then developed a classifier that integrates the host LRTI probability, abundance of respiratory viruses, and dominance in the lung microbiome of bacteria/fungi considered pathogenic by a rules-based algorithm.RESULTSThe host classifier achieved a median AUC of 0.967 by cross-validation, driven by activation markers of T cells, alveolar macrophages, and the interferon response. The integrated classifier achieved a median AUC of 0.986 and increased the confidence of patient classifications. When applied to patients with an uncertain diagnosis (n = 94), the integrated classifier indicated LRTI in 52% of cases and nominated likely causal pathogens in 98% of those.CONCLUSIONLower airway metagenomics enables accurate LRTI diagnosis and pathogen identification in a heterogeneous cohort of critically ill children through integration of host, pathogen, and microbiome features.FUNDINGSupport for this study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute (UG1HD083171, 1R01HL124103, UG1HD049983, UG01HD049934, UG1HD083170, UG1HD050096, UG1HD63108, UG1HD083116, UG1HD083166, UG1HD049981, K23HL138461, and 5R01HL155418) as well as by the Chan Zuckerberg Biohub.

Fractures negatively impact quality of life and survival. We hypothesized that recipient frailty score and genetic profile measured before transplant would predict risk of fracture after lung transplant. We conducted a retrospective cohort study of bone mineral density (BMD) and fracture among lung transplant recipients at a single center. The association between predictors and outcomes were assessed by multivariable time-dependent Cox models or regression analysis. Among the 284 participants, osteoporosis and fracture were highly prevalent. Approximately 59% of participants had posttransplant osteopenia, and 35% of participants developed at least 1 fracture. Low BMD was associated with a polygenic osteoporosis risk score, and the interaction between genetic score and BMD predicted fracture. Pretransplant frailty was associated with risk for spine and hip fracture, which were not associated with chronic lung allograft dysfunction or death. Chest fractures were the most frequent type of fracture and conferred a 2.2-fold increased risk of chronic lung allograft dysfunction or death (time-dependent P < .001). Pneumonia, pleural effusions, and acute rejection frequently occurred surrounding chest fracture. Pretransplant frailty and recipient genotype may aid clinical risk stratification for fracture after transplant. Fracture carries significant morbidity, underscoring the importance of surveillance and osteoporosis prevention.

Introduction: Respiratory diseases constitute a major cause of morbidity and mortality worldwide. The objective of our study was to identify the causes and factors associated with the death of patients in the Pulmonology Department of the Treichville University Hospital. Patients and methods: This was a retrospective cross-sectional study analyzing patients who died while hospitalized in the Pneumology Department of Treichville University Hospital between April 2019 and April 2020. Results: The study covered 514 files, including 177 deaths, representing an overall mortality of 34.4%. There were 109 men and 68 women with an average age of 45.20 years. The main antecedents were HIV infection (42.18%) and tuberculosis (38.1%). The main causes of death were pulmonary tuberculosis (49.69%), pneumocystosis (20.75%), and bacterial pneumonia (18.87%). Severe anemia (53.68%) and severe renal failure (19.85%) were the biological abnormalities associated with pulmonary pathologies. In univariate analysis, the factors associated with deaths were age less than 25 years, HIV seropositivity, nonmedical access to the service, self-medication, the presence of signs of initial clinical and radiological severity, a diagnosis of tuberculosis and neoplastic pathology, also the existence of difficulties during hospitalization. Multivariate analysis revealed HIV infection [odds ratio (OR)=1.46, confidence interval (CI)=0.27–0.77, P=0.003], diagnosed pulmonary tuberculosis (OR=1.51, CI=0.30–0.87, P=0.01), the presence of signs of clinical severity (OR=1.20, CI=0.09–0.42, P=0.00) and initial radiological severity (OR=1.27, CI=0.11–0.64, P=0.003) and the presence of difficulties during hospitalization (OR=1.16, CI=0.05–0.54, P=0.003). Conclusion: Mortality remains high in pulmonology hospitalizations. Currently, tuberculosis and HIV infection are the main causes of death. Efforts to combat these two conditions must be strengthened by taking into account these factors associated with deaths. [ABSTRACT FROM AUTHOR]

Introduction: In spontaneously breathing neonates, surfactant can be administered via thin catheter while enabling the own breathing (less invasive surfactant administration [LISA]). Alternatively, the neonate is intubated for surfactant delivery (intubation, surfactant, rapid extubation [INSURE]). Thus, the aim was to provide an overview of the efficacy of the LISA compared to INSURE. Methods: We performed an umbrella review of previous meta-analyses including randomized controlled trials. We searched PubMed, Scopus, and Web of Science in July 2023. Two authors screened the search results, and systematic reviews with meta-analyses that focused on LISA versus INSURE were included. One author extracted, and another author validated the extracted data. AMSTAR-2 and ROBIS evaluations were performed by two authors independently. Results: A total of 9 systematic reviews with meta-analyses were included. The quality according to AMSTAR-2 was high in one, moderate in one, low in three, and critically low in four. According to ROBIS, the risk of bias was low in three and high in six of the reviews. LISA was more effective than INSURE in preventing mechanical ventilation (8/8 reviews), death or BPD (4/4 reviews), death (3/9 reviews), and BPD (3/9 reviews). Conclusions: All the included systematic reviews and meta-analyses reported LISA to be more effective than INSURE in terms of need for mechanical ventilation and death or BPD. However, the quality of the published systematic reviews has been mostly deficient. Future systematic reviews should focus on reporting quality. [ABSTRACT FROM AUTHOR]

Monoterpene and 5-methylcoumarin- or 5-methylchromone-coupled meroterpenoids occurring mainly in the Asteraceae species proved to have high potency against protozoans, worms, and various tumor cells, which make them interesting targets for searching for new bioactive compounds. The African plant Centrapalus pauciflorus was applied in traditional medicine for healing chest pain and stomach aches. Three new meroterpenoids named centrapalus coumarin N (2), pauciflorins P (3), and Q (4), and the already known cyclohoehnelia coumarin (1), were isolated from the chloroform extract of C. pauciflorus, together with centrapalus coumarin O (5), which was obtained for the first time from a natural source. The structures were established from HRESIMS, 1D (1H NMR, 13C NMR JMOD) and 2D NMR (HSQC, HMBC, 1H-1H COSY, NOESY) spectroscopies, and the absolute stereochemistry of 5 was determined by single-crystal X-ray diffraction. Compounds 1, 2, and 5 are hybrid molecules of 5-methylcoumarin–monoterpene origin. Centrapalus coumarin N is the first example of meroterpenoids, where a monoterpene is fused with a coumarin and an acetophenone unit. Pauciflorins P and Q are dimeric meroterpenoid isomers. Centrapalus coumarins N and O were tested for antiproliferative activity against human adherent breast (MCF-7, MDA-MB-231), cervical (HeLa, SiHa), and ovarian (A2780) cancer cell lines, and were additionally included to obtain data concerning cancer selectivity. Both compounds exhibited moderate (IC50 > 10 µM) but selective activity against A2780 cells. [ABSTRACT FROM AUTHOR]

Malignant Central Airway Obstruction (MCAO) encompasses significant and symptomatic narrowing of the central airways that can occur due to primary lung cancer or metastatic disease. Therapeutic bronchoscopy is associated with high technical success and symptomatic relief and includes a wide range of airway interventions including airway stents. Published literature suggests that stenting practices vary significantly across the world primarily due to lack of guidance. This document aims to address this knowledge gap by addressing relevant questions related to airway stenting in MCAO. An international group of 17 experts from 17 institutions across 11 countries with experience in using airway stenting for MCAO was convened as part of this guideline statement through the World Association for Bronchology and Interventional Pulmonology (WABIP). We performed a literature and internet search for reports addressing six clinically relevant questions. This guideline statement, consisting of recommendations addressing these six PICO questions, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with expert experience when necessary. Panel members participated in the development of the final recommendations using the modified Delphi technique. [ABSTRACT FROM AUTHOR]

AIM: The aim of the study was to assess adherence to asthma controller therapy and factors that influence asthma control and to determine the association between asthma knowledge of the caregiver and asthma control among admitted children with asthma. SETTINGS AND DESIGN: A cross-sectional study was conducted between November 2022 and May 2023 in a tertiary care hospital. Children with a diagnosis of asthma aged 2--14 years, who were admitted to the hospital with an exacerbation of asthma were identified. METHODS: Caregivers of the admitted children were interviewed using the Asthma Knowledge Questionnaire and Pediatric Inhaler Adherence Questionnaire. STATISTICAL ANALYSIS USED: Demographic and clinical data were described using descriptive analyses, where mean and standard deviation were used for normally distributed continuous variables, median and interquartile range (IQR), if otherwise. A P < 0.05 was set as a cutoff for statistical significance. RESULTS: A total of 144 caregivers completed the survey. Median score for parents' knowledge of asthma was 64%, with an IQR of 59-67. Both mother's and father's educational levels were associated with a good level of knowledge: odds ratio (OR) = 2.48, 95% confidence interval (CI) = 1.1-5.6, and OR = 5.33, 95% CI = 2.23-12.7, respectively. Median adherence to metered dose inhaler (MDI) was 4 (IQR = 2-6). Children who had been admitted to the general ward in the last 6 months were three times more likely to be nonadherent to MDI (OR = 3.03, 95% CI = 1.18-7.82). Forty-three percent of children who were nonadherent to MDI were less likely to have their asthma controlled (OR = 0.43, 95% CI = 0.17-1.06). CONCLUSION: This study revealed that a low level of knowledge among caregivers of asthma patients is linked to inadequate adherence to asthma controller therapy. As medication adherence is crucial for achieving desirable asthma control and improving the quality of life for this population, efforts need to be made to enhance the knowledge level of parents of children with asthma. [ABSTRACT FROM AUTHOR]

Thoracic ultrasound (TUS) is a tool that has become increasingly essential in the daily practice of thoracic medicine. Driven by the need to assess patients during the COVID-19 pandemic, there has been an increase in the use of point-of-care TUS, which has demonstrated several benefits, either as a complement to clinical decisionmaking for diagnosis or as a real-time guide for procedures, whether as a predictor or measure of treatment response. Here, we present a review of TUS, based on the most recent scientific evidence, from equipment and techniques to the fundamentals of pulmonary ultrasound, describing normal and pathological findings, as well as focusing on the management of lung disease and guidance for invasive thoracic procedures at the bedside. Finally, we highlight areas of perspective and potential lines of research to maintain interest in this valuable tool, in order to improve the diagnostic process and expand the treatment arsenal. [ABSTRACT FROM AUTHOR]

Halo gravity traction (HGT) is a preoperative modality for children with severe spinal deformity used to optimize spine flexibility and balance while decreasing the likelihood of neurologic injury. HGT is a dependable solution for these challenging spinal deformities. Aligning treatment guidelines and providing resources, education, and training for staff are key components for a successful HGT program. The HGT program at Children's Mercy Hospital was then developed with a systems approach with the holistic goal of multidisciplinary collaboration with physical/occupational therapy, hospital medicine, pulmonology, psychology, nutrition, child life, and complex care management. Education, research, and national collaboration to standardize this therapy should improve patient safety and support quality improvement. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is linked with progressive but not fully reversible airflow obstruction. Spirometry is the gold standard test for diagnosis of COPD with FEV1/FVC <70%. Forced expiratory volume in one second (FEV1) is used to divide COPD severity into different categories. Objective: To determine the correlation between FEV1 and Polycythemia in COPD. Methodology: A cross-sectional study was conducted at Department of Pulmonology, Khyber Teaching Hospital (KTH), Peshawar from September, 2021, to March, 2022. After taking written approval from CPSP, all COPD patients of Medical and Pulmonology unit of KTH Peshawar fulfilling the inclusion criteria were assessed. Written informed consent was taken from all study patients. On arrival a detailed history was taken followed by physical examination with special focus on the presence of polycythemia. Data was analysed by SPSS version 23. Results: Out of total 140 patients, the majority (60.3%) were females. The mean age was 54.93 (± 9.31) years while the mean duration of COPD was 7.57 (± 3.42) years. The mean BMI was 27.27 (± 4.08) Kg/ m². Polycythemia was observed in these 11 (08%) patients. By applying the Chi-square test, there was no statistically significant association between FEV1 and polycythemia (p = 0.69). On Pearson co-efficient correlation, there was no significant correlation between FEVI and polycythemia (rr=0.08, p =0.34). Conclusion: COPD is an important health issue that can lead to a number of complications including polycythemia. FEV1 has no significant association with polycythemia. However, earlier screening for polycythemia is recommended to avoid the sequalae of this complication in patients with COPD. [ABSTRACT FROM AUTHOR]

Background: The accurate and timely completion of patient admission notes is crucial for high-quality patient care and effective communication among healthcare providers. In the Pulmonology ward, where patients with respiratory conditions receive specialized treatment, comprehensive and prompt documentation of admission information is paramount. The complexity of these conditions and potential for acute exacerbations make accurate and timely documentation even more critical for guiding appropriate interventions and ensuring patient safety. Methodology: This uni-disciplinary audit reviewed prospective admission records and associated data for each patient over one month, with a sample size of 75 patients. The initial audit was conducted from June to July 2023 in the Pulmonology ward of Bahawal Victoria Hospital, Quaid-e-Azam Medical College Bahawalpur. Following initial audit recommendations, a proforma on patient admission notes with pre-written variables was created and explained to house officers and postgraduate residents. A subsequent re-audit was conducted from September to October 2023 to compare results with the initial audit. Results: The audit findings indicated a need for improvement in the timeliness of patient attendance and the documentation of initial assessments, vital signs, and treatment plans. The re-audit suggested improvements in patient attendance timeliness and initial assessment with vital sign recordings. However, the treatment chart signatures, and postgraduate resident stamps still needed improvement. Conclusion: Implementing the suggested recommendations can enhance patient care and ensure compliance with established protocols. Regular monitoring and follow-up audits are recommended to evaluate the effectiveness of the changes. [ABSTRACT FROM AUTHOR]

In this article, the authors provide guidance for applicants to any subspecialty in the medical specialties matching program, with a particular focus on those seeking a match into a pulmonary or critical care medicine training program, or both. The preparation, application, interview, ranking, and match steps are used to discuss available literature that informs this process. Preparing a fellowship application is discussed in terms of personal career goals, and specific strategies are suggested that can help a candidate to assess a program's fit with those goals. In addition to review of recent data on virtual interviewing and interview questioning, the authors provide practical recommendations for candidates seeking to maximize their success in the current interview environment. Finally, key points about generating a rank order list are summarized. This resource will prove useful to any candidate pursuing medical subspecialty training in the current era. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is one of the top three causes of death throughout the world. Because of the preventable and treatable nature of the disease along with its prevalence, COPD represents a major public health challenge. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report provides a review of the most current evidence for prevention of COPD as well as the assessment, diagnosis, and treatment of people with the disease. The purpose of this article is to provide a summary of the 2024 revised GOLD Report and current best practices in accordance with the evidence. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with autoimmune systemic inflammation. The evidence on the role of C-reactive protein (-CRP) in predicting mortality among people with COPD remains mixed. Methods: Data from the National Health and Nutrition Examination Survey (1999–2010) were linked with mortality files up to December 31st, 2019, from the National Death Index. Adults ages 20 years or older were included in the analytic sample to assess the relationship between physician-diagnosed self-reported COPD and mortality based on blood CRP levels. Multivariate complex samples Cox regression analyses were conducted to determine the hazards ratios (with 95% CI). Results: A total of 30,669 individuals comprised of the final sample with 2215 deaths observed upon follow-up for an average of 10.2 years. Compared to individuals without COPD or elevated CRP, individuals with COPD but without elevated CRP (HR = 1.25, 95% CI = 0.97–1.61) did not have a significantly higher risk of mortality. However, those with both COPD and elevated CRP had a significantly higher risk of mortality (HR = 2.70, 95% CI = 1.08–6.81). Age, health insurance status, and a history of comorbidities modified these relationships. Conclusions: Biomarkers such as CRP continue to show promise for long-term COPD-related outcomes. Additional prospective assessments of individuals with airway obstruction are warranted to understand if CRP levels predict the occurrence or worsening of COPD and if those relate to long-term health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic efficacy and safety of fine needle aspiration cytology performed under ultrasound guidance. Study Design: Comparative prospective study. Place and Duration of Study: Pulmonology Out-Patient Department, Gulab Devi Teaching Hospital, Lahore Pakistan, from Jun 2018 to Dec 2019. Methodology: One hundred and twenty-four patients of age 10-80 years, with pulmonary, mediastinal, pleural or chest wal lesions, fulfiling the minimal fitness criteria were included. Aspiration was done by a 23-gauge needle, smear made, and fixed slides were sent to the Cytology Department for evaluation. Complications were monitored. Findings were recorded on preformed proforma. Results: 121/124(97.6%) aspirates were adequate while 03 cases (2.4%) were reported not representing the lesion. Fifty cases (41.3%) showed malignant cytology, 71/121 aspirates (58.7%) were non-malignant. A specific cel type could be characterized in 84.5% non-malignant and 68.0% malignant aspirates. Complications were a few drops bleeding at needle aspiration site in 7.5 % and minor pain in 12.0 % patients. Conclusion: Fine needle aspiration cytology under ultrasound guidance is an effective and safe diagnostic tool in pulmonary medicine. [ABSTRACT FROM AUTHOR]

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The field of pulmonology saw significant advances in 2023. The publications highlighted in this article address advances and changes in practice related to asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, pleural disorders, and sleep-disordered breathing. One article reviews data examining the efficacy of vaccination against respiratory syncytial virus, a respiratory viral illness that has had devastating effects globally. Four studies evaluate the role of various therapies in COPD, including dupilumab, ensifentrine, pulmonary rehabilitation programs, and lung volume reduction versus endobronchial valves. Another study explores the effect on vascular events of positive-pressure ventilation in patients with sleep-disordered breathing and recent stroke. The use of combination therapy with rituximab and mycophenolate mofetil on progression-free survival in patients with nonspecific interstitial pneumonia is the topic of another study. We also highlight an update of clinical recommendations for the evaluation of patients with pleural disorders and a systematic review analyzing the effectiveness of inhaled corticosteroids as a supplement to dual therapy for COPD. [ABSTRACT FROM AUTHOR]

Background: Although frailty is one of the aging syndromes, it can occur at a younger age and in individuals with organ diseases. Identifying frailty and pre-frailty in patients with chronic respiratory diseases (CRDs) is an emerging assessment in the field of pulmonary medicine and rehabilitation. The aim of this study was to find out the prevalence of frailty among chronic respiratory disease patients. Methods: A single centre cross-sectional survey study with a total population of 381 patients, adults aged 18-90 years presenting to the pulmonology OPD was included based on the inclusion and exclusion criteria. Primary data collected were demographics, medical history, including comorbidities, use of long-term oxygen therapy (LTOT), BiPAP (Bilevel Positive Airway Pressure), previous hospital admissions, medication history and frailty assessment were done using the Fried frailty index. Results: Univariate analysis showed that sex, ECHO abnormality, patients using LTOT, BiPAP, home nebulizers and patients who did not attend the pulmonary rehabilitation programme had a significant association with frailty. Multivariate analysis showed that female sex, LTOT use and older age were significantly associated with frailty. Conclusion: Frailty is frequent in CRD patients regardless of age. The prevalence of frailty has an association with female sex, patients using LTOT, and home BiPAP. [ABSTRACT FROM AUTHOR]

The article focuses on the establishment of a new subspecialty in pulmonary medicine dedicated to addressing chronic respiratory failure. It highlights the need for standardized criteria, education, and training programs to meet the growing demand for expertise in this area. It discusses the challenges and gaps in current clinical practice and proposes interdisciplinary collaboration and policy changes to improve patient care.

Introduction: Single-station N2 (ssN2) versus multi-station N2 has been used as a selection criterion for treatment recommendations between surgical versus non-surgical multimodality treatment in stage III-N2 NSCLC. We hypothesized that clinical staging would be susceptible to upstaging on pathologic staging and, therefore, challenge this practice. Methods: A retrospective study of prospectively collected routine clinical data for patients with stage III-N2 NSCLC that had completed computed tomography (CT), positron emission tomography (PET), and staging endobronchial ultrasound (EBUS) and had been confirmed clinical stage III-ssN2 at multidisciplinary team discussion and went on to complete surgical resection as the first treatment to provide pathologic staging. The study was completed in two cohorts (A) across a single cancer alliance in England (Greater Manchester) January 1, 2015 to December 31, 2018 and (B) across five United Kingdom centers to validate the findings in part A January 1, 2016 to December 31, 2020. Results: A total of 115 patients met the inclusion criteria across cohort A (56 patients) and cohort B (59 patients) across 15 United Kingdom hospitals. The proportion of cases in which clinical stage III-ssN2 was upstaged to pathologic stage III-multi-station N2 was 34% (19 of 56) in cohort A, 32% in cohort B (19 of 59), and 33% across the combined study cohort (38 of 115). Most patients had a single radiologically abnormal lymph node on CT and PET (88%, 105 of 115). In the majority, the reasons for missed N2 disease on staging EBUS were due to inaccessible (stations 5, 6, 8, 9) N2 nodes at EBUS (34%, 13 of 38) and accessible lymph nodes not sampled during staging EBUS as not meeting sampling threshold (40%, 15 of 38) rather than false-negative sampling during EBUS (26%, 10 of 38). Conclusions: During multidisciplinary team discussions, clinicians must be aware that one-third of patients with stage III-ssN2 on the basis of CT, PET, and staging EBUS do not truly have ssN2 and this questions the use of this criterion to define treatment recommendations.

PURPOSE: Half of people living with chronic obstructive pulmonary disease (COPD) do not receive high-quality, evidenced-based care as described in international guidelines. We conducted secondary data analysis of a previously published study to assess the ability of a model of lay health coaching to improve provision of guideline-based care in a primary care setting. METHODS: As part of a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive usual care or 9 months of health coaching from primary care personnel informed by a pulmonary specialist practitioner. Outcome measures included prescription of appropriate inhaler therapy, participation in COPD-related education, engagement with specialty care, prescription of smoking cessation medications, and patient ratings of the quality of care. RESULTS: Baseline quality measures did not differ between study arms. At 9 months, coached patients were more likely (increase of 9.3% over usual care; P=0.014) to have received guideline-based inhalers compared to those in usual care. Coached patients were more likely to engage with pulmonary specialty care (increase of 8.3% over usual care with at least 1 visit; P=0.04) and educational classes (increase of 5.3% over usual care; P=0.03). Receipt of smoking cessation medications among patients smoking at baseline in the health coaching group increased 21.1 percentage points more than in usual care, a difference near statistical significance (P=0.06). CONCLUSIONS: Health coaching may improve the provision of quality chronic illness care for conditions such as COPD.

Clinical outcomes after lung transplantation, a life-saving therapy for patients with end-stage lung diseases, are limited by primary graft dysfunction (PGD). PGD is an early form of acute lung injury with no specific pharmacologic therapies. Here, we present a large multicenter study of plasma and bronchoalveolar lavage (BAL) samples collected on the first posttransplant day, a critical time for investigations of immune pathways related to PGD. We demonstrated that ligands for NKG2D receptors were increased in the BAL from participants who developed severe PGD and were associated with increased time to extubation, prolonged intensive care unit length of stay, and poor peak lung function. Neutrophil extracellular traps (NETs) were increased in PGD and correlated with BAL TNF-α and IFN-γ cytokines. Mechanistically, we found that airway epithelial cell NKG2D ligands were increased following hypoxic challenge. NK cell killing of hypoxic airway epithelial cells was abrogated with NKG2D receptor blockade, and TNF-α and IFN-γ provoked neutrophils to release NETs in culture. These data support an aberrant NK cell/neutrophil axis in human PGD pathogenesis. Early measurement of stress ligands and blockade of the NKG2D receptor hold promise for risk stratification and management of PGD.

Background: Dental needle aspiration is a rare complication of oral procedures given the advances in medical technology. Aspirations in general may also be asymptomatic, apart from the possible remote history of upper airway irritation at the time of induction. Clinicians should take a detailed history and examination, along with appropriate diagnostic imaging before discharging these patients from the emergency department. Case presentation: A young patient presented with an acute complaint of pain and coughing post-dental procedure. On arrival at the emergency department, she was vitally and clinically stable, without signs of respiratory distress. There were no complaints reported apart from minor throat pain. Imaging done in the emergency department revealed the presence of a 32 mm needle in the distal airway. She underwent emergency flexible bronchoscopy, and the foreign body was removed under direct visualization. The patient remained stable throughout the procedure and had an uneventful stay until discharge. Conclusion: While needle aspiration is a relatively uncommon occurrence, its early detection is always critical before further damage to local structures can occur. Regardless of presentation and symptoms, basic imaging is mandatory before the disposition is decided. [SJEMed 2024; 5(1.000): 058-060]

The authors offer a response to a commentary made on their study identifying peripheral blood proteomic biomarkers of transplant-free survival in patients with idiopathic pulmonary fibrosis (IPF). Topics include association between increasing bacterial burden within the lung and mortality, significant source of biological heterogeneity which is tied to adverse clinical outcomes, and a key understudied determinant of disease course in IPF.

We describe a case report of a patient with Blastomycosis-induced acute respiratory distress syndrome (ARDS) and severe hypoxemia requiring mechanical ventilation, prone positioning, and neuromuscular blockade whose clinical condition rapidly improved with the use of corticosteroids resulting in the patient being discharged home without the need for supplemental oxygen. [ABSTRACT FROM AUTHOR]

Background: Introducing innovations in the healthcare sector often involves testing groundbreaking solutions, ranging from advanced diagnostic technologies to new therapies and modern patient data management systems. Thorough and systematic risk monitoring not only enhances the chances of project success but also constitutes a crucial element in building trust in innovative healthcare solutions. Aim of the study: presenting and discussing risks and risk management strategies in a pilot project implementing telemedical solutions in the field of pulmonology. Materials and methods: The paper analyzed key risks along with remedial actions taken during the implementation of a pilot telemedical project in the field of pulmonology. Systematic analyses covered technological, financial, legal, organizational, external, clinical, and competency areas. The description of a specific project case was used, along with a narrative of personal experiences during its execution in the given year. Results: The telemedical project for patients with chronic obstructive pulmonary disease (COpd), focusing on clinical assessment and observation of spirometric parameters, aimed to address the challenges related to the care of individuals with COpd. The innovative aspects of the pilot project were emphasized, along with its potential impact on improving pulmonological care. The paper discusses aspects related to risk management and remedial actions, identifying areas where the project could serve as a model for further research and practices in the field. Conclusions: The coordination of medical teams, primary care physicians, pulmonology specialists, and nurses with strong and multifaceted administrative support constituted a key element of remedial actions. This collaboration enabled effective counteraction against potential negative consequences of testing telemedical solutions in pulmonology by implementing appropriate corrective measures and efficient remedial actions. [ABSTRACT FROM AUTHOR]

BACKGROUND: This narrative review aims to explore the current state and future perspective of artificial intelligence (AI) in respiratory care. The objective is to provide insights into the potential impact of AI in this field. METHODS: A comprehensive analysis of relevant literature and research studies was conducted to examine the applications of AI in respiratory care and identify areas of advancement. The analysis included studies on remote monitoring, early detection, smart ventilation systems, and collaborative decision-making. RESULTS: The obtained results highlight the transformative potential of AI in respiratory care. AI algorithms have shown promising capabilities in enabling tailored treatment plans based on patient-specific data. Remote monitoring using AI-powered devices allows for real-time feedback to health-care providers, enhancing patient care. AI algorithms have also demonstrated the ability to detect respiratory conditions at an early stage, leading to timely interventions and improved outcomes. Moreover, AI can optimize mechanical ventilation through continuous monitoring, enhancing patient comfort and reducing complications. Collaborative AI systems have the potential to augment the expertise of health-care professionals, leading to more accurate diagnoses and effective treatment strategies. CONCLUSION: By improving diagnosis, AI has the potential to revolutionize respiratory care, treatment planning, and patient monitoring. While challenges and ethical considerations remain, the transformative impact of AI in this domain cannot be overstated. By leveraging the advancements and insights from this narrative review, health-care professionals and researchers can continue to harness the power of AI to improve patient outcomes and enhance respiratory care practices. IMPROVEMENTS: Based on the findings, future research should focus on refining AI algorithms to enhance their accuracy, reliability, and interpretability. In addition, attention should be given to addressing ethical considerations, ensuring data privacy, and establishing regulatory frameworks to govern the responsible implementation of AI in respiratory care. [ABSTRACT FROM AUTHOR]

Aim: Asthma scoring systems rely on physical examination findings. Point of care ultrasound may provide an objective means to document improvement in the work of breathing in paediatric lower airway obstruction. Methods: Thirty children with wheeze on physical examination (cases) and 15 children presenting with abdominal pain (controls) were studied. Using point‐of‐care ultrasound, m‐mode tracing of lung was recorded above the right hemidiaphragm at the midclavicular line. Pleural line slope and excursion were measured before and after treatment. Results: Twenty patients had a final slope measurement under 20°, and only three were admitted—one for hypoxia that resolved prior to ascending to the ward and another for poor compliance. Average decrease in pleural line slope after treatment was 43% and average decrease in pleural line excursion was 32%. Of the 10 children admitted, 8 had measurements over 25°. The correlation coefficient between pleural slope and pleural excursion was 0.67. All controls had a horizontal m‐mode tracing at the pleural line. Conclusion: Oscillation of the m‐mode line at the pleura is seen in children with lower airway obstruction and is absent in controls. There appears to be a correlation between beta‐agonist therapy and decreased pleural line slope and excursion. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium tuberculosis is the cause of pulmonary tuberculosis (TB), a highly morbid disease that is linked to a number of co-morbid illnesses. Similar to other lung conditions, smoking is regarded as a major risk factor for tuberculosis in the lungs. Objective: To find out how common smoking is among pulmonary tuberculosis patients at Khyber Teaching Hospital's pulmonology department. Methodology: A cross-sectional study was conducted in the pulmonology department of the Khyber Teaching Hospital in Peshawar between March 17 and September 16, 2022. A non-probability consecutive sampling method was utilized to include in the study 157 patients, aged 15 to 70, who had pneumonia brought on by tuberculosis, regardless of gender. The trial was approved by the hospital ethical committee, and the patients who took part provided written informed permission. Each patient's information was entered into a well-organized proforma. The frequency of smoking among the patients was noted. Data was entered using SPSS 23. Results: 60.5% of the total 157 patients were men and 39.5% were women. An average age was 37.13 +/- 16. 3.3±1.1 weeks was the mean duration of tuberculosis. The average time spent smoking was 59.9 +/- 3.1 months. In 38.2% and 28% of the patients, accordingly, there was diabetes and hypertension. Among all patients, smokers made up 30.6%. Conclusion: Patients with pulmonary tuberculosis frequently smoke; of those with the disease, 30.6% are reported smokers. This highlights the necessity of smoking reduction initiatives as a component of tuberculosis treatment to enhance results. Comprehensive care also necessitates treating co-morbid illnesses such as diabetes and hypertension. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to evaluate the diagnostic value of rapid on‐site evaluation (ROSE) combined with computed tomography‐guided percutaneous needle biopsy (CT‐PNB) or radial endobronchial ultrasound‐guided transbronchial lung biopsy (EBUS‐TBLB) for pulmonary cryptococcosis (PC). Methods: Clinical data of 33 patients diagnosed with PC at the Third Affiliated Hospital of Soochow University between February 2018 and June 2023 were retrospectively analysed. Patients were divided into the CT‐PNB and EBUS‐TBLB groups based on the intervention method, and the diagnostic positivity rate and incidence of complications were compared between the two groups. Results: Compared with the final diagnosis, the positive diagnostic rates of ROSE, histopathology and serum CrAg of all patients were 81.8% (27/33), 72.7% (24/33) and 63.6% (21/33), respectively. The average turnaround times of the three methods were 0.1 (0.1–0.2) h, 96.0 (48.0–120.0) h and 7.8 (4.5–13.6) h, respectively (P < 0.001). The coincidence rate between histopathology and ROSE was 84.8% with a kappa value of 0.574. The positive diagnostic rate for PC was significantly higher in the CT‐PNB group than in the EBUS‐TBLB group (92.9% vs. 57.9%), and the difference was statistically significant (P < 0.05). Combined with the ROSE results, the positive diagnostic rate in the EBUS‐TBLB group increased to 84.2% (16/19). Conclusion: ROSE has commendable accuracy and timeliness, and CT‐PNB offers further advantages in this regard. ROSE enhances the diagnostic efficiency of EBUS‐TBLB for PC and is safe and effective. [ABSTRACT FROM AUTHOR]

Medical professionals in thoracic medicine routinely analyze chest X-ray images, often comparing pairs of images taken at different times to detect lesions or anomalies in patients. This research aims to design a computer-aided diagnosis system that enhances the efficiency of thoracic physicians in comparing and diagnosing X-ray images, ultimately reducing misjudgments. The proposed system encompasses four key components: segmentation, alignment, comparison, and classification of lung X-ray images. Utilizing a public NIH Chest X-ray14 dataset and a local dataset gathered by the Chiayi Christian Hospital in Taiwan, the efficacy of both the traditional methods and deep-learning methods were compared. Experimental results indicate that, in both the segmentation and alignment stages, the deep-learning method outperforms the traditional method, achieving higher average IoU, detection rates, and significantly reduced processing time. In the comparison stage, we designed nonlinear transfer functions to highlight the differences between pre- and post-images through heat maps. In the classification stage, single-input and dual-input network architectures were proposed. The inclusion of difference information in single-input networks enhances AUC by approximately 1%, and dual-input networks achieve a 1.2–1.4% AUC increase, underscoring the importance of difference images in lung disease identification and classification based on chest X-ray images. While the proposed system is still in its early stages and far from clinical application, the results demonstrate potential steps forward in the development of a comprehensive computer-aided diagnostic system for comparative analysis of chest X-ray images. [ABSTRACT FROM AUTHOR]

Non-invasive positive pressure ventilation (NIPPV) is increasingly used as a treatment method for patients with respiratory failure. The first recommendations for the use of NIPPV in Slovakia were developed by the Slovak Society of Pulmonology and Phthisiology in 2007 and were partially revised in 2015. New scientific evidence prompted the present update, which is based on widely accepted international guidelines and was adapted to address local needs. Important features of the present update include a classification of acute indications for NIPPV into three categories based on the level of supporting evidence, namely 1. definite indications for in-hospital use of NIPPV; 2. possible indications for in-hospital use of NIPPV; and 3. disorders and states in which in-hospital use of NIPPV is not recommended. The current update also reflects the importance of comorbid sleep-related breathing disorders and other chronic respiratory conditions, as well as the use and limitations of continuous positive airway pressure therapy. Since oxygen therapy is often administered along with NIPPV, guidance on the safe use of oxygen in NIPPV-treated patients has also been included. Also, the present update extends the range of its users, addressing the needs of specialists in pediatric respiratory medicine as a novelty. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer carries the highest cancer-related mortality rates worldwide. Despite all recent advances, the mortality from lung cancer is still rising. A better understanding of the risk factors may help us predict responses to chemotherapy for better management. Aim: To evaluate predictors of response to chemotherapy in advanced Non-Small Cell Lung Cancer (NSCLC) patients. Materials and Methods: This was a prospective cohort study conducted in the Department of Pulmonary Medicine at Government Medical College and Hospital, Chandigarh, India. A total of 60 confirmed cases of advanced (stage IIIB and IV) NSCLC patients were enrolled consecutively for a duration of two years. Baseline clinical parameters, routine blood tests, spirometry, exercise capacity using the 6 Minute Walk Test Distance (6MWTD), and Computed Tomography (CT)-based tumour size were recorded. Certain pre-defined patient, disease, and therapy-related factors (age, gender, dyspnoea, baseline blood tests, tumour size, histology, etc.) were evaluated for their possible role as predictors of treatment response in advanced NSCLC patients. A positive response was defined if the response to chemotherapy was Complete Response (CR) or Partial Response (PR), and a negative response if the response was Progressive Disease (PD) or Stable Disease (SD) as per revised RECIST (Response evaluation criteria in solid tumors) 1.1 criteria. Variables between the two groups were compared using the Mann-Whitney U test and Chi-square test. To find out the factors that may predict response to treatment, univariate and multivariate logistic regression analysis were used. Results: Out of a total of 60 confirmed cases of NSCLC patients, only 40 patients were able to complete the four cycles of chemotherapy. The mean age of the patients was 58.5±9.6 years. There were a total of 35 males (87.5%) and five females (12.5%) in the study. Out of 40 patients, 27 (67.5%) had squamous cell carcinoma and 13 (32.5%) had adenocarcinoma. On univariate analysis, Neutrophil-Lymphocyte Ratio (NLR) had a statistically significant association with tumour response (p<0.001). On multivariate analysis, advanced age (p=0.05) and high (>3.81) NLR (p=0.002) were found as independent predictors of poor response to chemotherapy. Conclusion: Pre-treatment high NLR and advanced age are significant factors for a poor response to chemotherapy treatment in advanced NSCLC patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Incorrect usage of inhaler devices might have a significant influence on the clinical effectiveness of the drug delivered. This issue is poorly addressed; hence, the study was designed to investigate the knowledge and ability of the healthcare professional student community to use inhaling devices. Poor inhalation techniques are associated with decreased medication delivery and poor disease control in chronic obstructive pulmonary disease (COPD) AIMS AND OBJECTIVES: To study knowledge, attitude, and practice of inhalation therapy among obstructive airway disease patients. Methods: This cross-sectional study was done in the outpatient Pulmonary medicine department in Mahatma Gandhi Medical College and Research Institute, Pondicherry. From 2013 to 2016. All patients with history and symptoms suggestive of obstructive airway disease attending the Pulmonary Medicine outpatient department will be included in the study. A patient who is already on inhalation therapy will be screened and their knowledge will be assessed and their attitude and practice of using inhalation therapy will be checked using structured prevalidated questionnaire. Results: About 74% preferred the use of inhalers in asthma. However, about 43% liked to use oral medications more than inhaled medicines. About 55% believed that inhaled medications contain a higher dose than oral. About 76% of patients believed that they need to continue inhalers life-long once started. Although 54% claimed to use inhalers regularly, only 29% used to bring their device for follow-up assessment, while 33% admitted that they don't know how to use their inhaler properly. Conclusion: Inhalation technique in COPD patients without face-to-face training was mostly unsatisfactory, especially in patients with low education levels. The Handihaler was the inhaler device associated with the lowest technique failure. Face-to-face inhalation technique training significantly increased technique compliance for the pMDI. [ABSTRACT FROM AUTHOR]

Bronchial artery embolization (BAE) is a procedure that aims to control bleeding from bronchial arteries in massive and chronic haemoptysis. It is considered to be a life-saving measure in severe life-threating haemoptysis. Although it is minimally invasive and has a high success rate, it still carries a list of complications. These include post-embolisation syndrome, chest pain, back pain, dysphagia, vascular injury at the site of the embolisation leading to dissection, perforation, pseudoaneurysm and, very rarely, embolic infarction to non-target vessels. Stroke is one of the rare complications post BAE, and it can be severe and fatal. Few cases of stroke post BAE have been reported in the literature, and they were mainly due to posterior cerebral circulation infarction. Here, we report a case of a stroke post BAE due to massive middle cerebral artery (MCA) infarction and to our knowledge it seems to be the first reported case of MCA infarction post BAE. The discussion will cover the possible mechanisms of embolic passage, the outcome of the case including rehabilitation perspectives and the learning points. These will also highlight the importance of early recognition, which can save patients from a disabling stroke in the future.

Introduction: Asthma is a common inflammatory disease of airway affecting both adults and children. In a large number of cases asthma remains poorly controlled. There is a need to find an additional therapeutic demeanour alleviating symptoms and lowering the risk complications in a long-term. Recently, increasing number of studies has been examining dietary supplements in regards to their anti-inflammatory, immunomodulatory, anti-remodelling properties and their use in asthmatic patients. Aim of the Study: The aim of the study was to collect and analyse current literature regarding influence of different dietary supplements on the course of asthma in both adults and children. Methods and Materials: Extensive research was conducted using PubMed and Google Scholar, with the primary focus on literature from the past 5 years. Firstly, potential dietary supplements affecting course of asthma were collected. The names of the substances were juxtaposed with term “Asthma” to gather data regarding their effect on occurrence and control of asthma and potential mechanisms responsible for it. Additionally, references from selected articles were included in the analysis. Results: Dietary supplements show promising results in decreasing asthma symptoms and lowering inflammation of airway. However, our study revealed that in current state of knowledge there is a deficit of studies performed on humans, especially large-scale, prospective studies that assess the efficacy of different doses of dietary supplements. Thus, further research of dietary supplements in asthma is needed, especially large-scale randomised controlled trials.

Chronic type 2 (T2) inflammatory diseases of the respiratory tract are characterized by mucus overproduction and disordered mucociliary function, which are largely attributed to the effects of IL-13 on common epithelial cell types (mucus secretory and ciliated cells). The role of rare cells in airway T2 inflammation is less clear, though tuft cells have been shown to be critical in the initiation of T2 immunity in the intestine. Using bulk and single-cell RNA sequencing of airway epithelium and mouse modeling, we found that IL-13 expanded and programmed airway tuft cells toward eicosanoid metabolism and that tuft cell deficiency led to a reduction in airway prostaglandin E2 (PGE2) concentration. Allergic airway epithelia bore a signature of PGE2 activation, and PGE2 activation led to cystic fibrosis transmembrane receptor-dependent ion and fluid secretion and accelerated mucociliary transport. These data reveal a role for tuft cells in regulating epithelial mucociliary function in the allergic airway.