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Purpose: The search for an inexpensive agent for chemical pleurodesis in malignant pleural effusion (MPE) continues. We aimed to compare the efficacy and safety of iodopovidone versus doxycycline for pleurodesis in MPE. Methods: We randomized consecutive subjects with recurrent symptomatic MPE (1:1) to undergo pleurodesis with either doxycycline or iodopovidone administered through an intercostal tube. The primary outcome was the success rate of pleurodesis at 30 days. The secondary outcomes were the time to pleurodesis, chest pain (assessed using visual analog scale [VAS]) after pleurodesis, and complications (hypotension, acute respiratory failure, empyema). Results: We randomized 52 and 58 subjects to receive either doxycycline or iodopovidone. The mean (standard deviation [SD]) age of the study population (51% women) was 54.1 (13.6) years. Lung cancer (≥ 60%) was the most common underlying cause of MPE. We observed a similar frequency of success in the doxycycline vs. the iodopovidone group (complete response: 43 (82.7%) vs. 46 (79.3%) subjects; partial response: 7 (13.5%) vs. 10 (17.2%) subjects; p = 0.3). The mean (SD) time to pleurodesis was 1.5 (1.9) days and 1.9 (5.4) days in the doxycycline and iodopovidone groups, respectively. While the VAS for chest pain was significantly higher with iodopovidone (mean [SD] VAS: doxycycline, 31.9 [20.9]; iodopovidone, 41.3 [21.8]; p = 0.017), it did not reach the minimal clinically important difference. The complication rates were similar between the two groups. Conclusion: Iodopovidone was not superior to doxycycline for pleurodesis in MPE. Trial registration number/date: clinicaltrials.gov (NCT02583282) / October 22, 2015. [ABSTRACT FROM AUTHOR]

The article discusses a rare case of isolated tracheal mucormycosis in a patient with diabetes mellitus. The authors highlight the importance of bronchoscopic management in treating this condition, as nearly 30% of patients with isolated tracheobronchial mucormycosis may require therapeutic bronchoscopy. They describe a case in which a 49-year-old man with poorly controlled diabetes presented with airway obstruction due to mucormycosis and required airway stenting. The patient was successfully treated with a combination of bronchoscopic intervention and antifungal therapy. The article emphasizes the need for a high index of suspicion and appropriate management strategies for this uncommon condition. [Extracted from the article]

Background: Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID‐19) and perform a systematic review of the literature. Case description and systematic review: A 45‐year‐old gentleman with poorly controlled diabetes mellitus presented with cough, streaky haemoptysis, and hoarseness of voice 2 weeks after mild COVID‐19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycaemic control, posaconazole, and inhaled amphotericin B (8 weeks). Our systematic review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in two lung transplant recipients), post‐viral illness (post‐COVID‐19 [n = 3], and influenza [n = 1]), and post‐intubation mucormycosis (n = 1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26; 19.2%) or bronchoscopic instillation (1/26; 3.8%) of amphotericin B and surgery (6/26; 23.1%) were performed in some patients. The case‐fatality rate was 50%, primarily attributed to massive haemoptysis. Conclusion: Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible. [ABSTRACT FROM AUTHOR]

Background: Whether off‐site evaluation of slides by a cytologist viewing the images shared by WhatsApp improves the on‐site evaluation by a pulmonologist (P‐ROSE) remains unknown. This study's objective was to compare the sensitivity of P‐ROSE and WHOSE for adequacy and diagnosis of cytology specimens obtained by endobronchial ultrasound (EBUS)‐guided transbronchial needle aspiration (TBNA). Materials and Methods: We retrospectively reviewed our bronchoscopy database to identify subjects who underwent EBUS‐TBNA for lymph node sampling and had reports of P‐ROSE and WHOSE. We collected data on the adequacy of samples as reported by the pulmonologist (P‐ROSE), remotely by the cytologist (WHOSE), and finally after detailed cytologic evaluation. The study's primary outcome was to assess the increment in sensitivity for adequacy and diagnostic category (using the final cytology report as reference) by incorporating WHOSE. Results: We included 264 (P‐ROSE, n = 184; WHOSE, n = 80) subjects. The sensitivity (95% CI) for sample adequacy by P‐ROSE and WHOSE was 65.3% (57.9%‐72%) and 92% (83.6%‐96.2%), respectively. There was a 26.6% (95% CI, 16%‐35.2%) increment in the sensitivity for adequacy. The sensitivity (95% CI) for diagnosis by P‐ROSE and WHOSE was 53.9% (46%‐61.1%) and 89.8% (79.5%‐95.3%), respectively. There was a 35.9% (95% CI, 23.4%‐45%) increment in the sensitivity for diagnosis with WHOSE. The agreement between P‐ROSE and final cytology in adequacy was poor (κ = −0.023, p = 0.616). The agreement between WHOSE and final cytology was moderate for adequacy (κ = 0.491, p = <0.001). Conclusion: We found WHOSE significantly improves the performance of P‐ROSE for rapid assessment of cytology specimens obtained by EBUS‐TBNA. [ABSTRACT FROM AUTHOR]

Depression, anxiety, sleep disturbances, and fatigue are inadequately addressed comorbidities in granulomatosis with polyangiitis (GPA). We determined the prevalence, severity, determinants, and the impact of these comorbidities on quality-of-life (QoL) in GPA. This observational study included adult GPA patients; patients with RA and lupus were included as comparators. Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder 7-item scale for anxiety, Epworth Sleepiness Scale for sleep disturbances, and Fatigue Severity Scale for fatigue were administered prospectively to estimate prevalence and severity. QoL and disability were estimated using PROMIS-HAQ, HAQ-health and HAQ-pain. Correlations among these parameters were assessed. Stepwise regression analyses were performed to identify determinants of depression, anxiety, excessive sleepiness, and fatigue. One hundred eighty-one patients—62 GPA [mean age 43 (13) years], 57 RA and 62 SLE- were included. The prevalence of depression (47%), excessive sleepiness (21%), and fatigue (39%) in GPA were comparable to RA and lupus; anxiety was less prevalent (29% versus 46% and 53%, p = 0.02). Severity was mostly mild-moderate. Younger age [OR = 0.93 (0.89–0.98)], higher BMI [OR = 1.2 (1.0–1.4)], and greater disease damage [OR = 2.0 (1.3–3.3)] independently predicted presence of depression. Higher BMI [OR = 1.3 (1.1–1.5)] and concomitant FMS [OR = 80.9 (5.1–1289.2)] were independently associated with excessive sleepiness. No association with disease activity, duration, or gender was seen. GPA patients with depression, anxiety, excessive sleepiness, and fatigue had worse PROMIS-HAQ, HAQ-pain, and HAQ-health. In conclusion, depression, anxiety, sleep disturbances, and fatigue are common in GPA. Although their severity is mostly mild-moderate, they impair QoL significantly. Potentially modifiable determinants that can form targets for future interventions have been identified. [ABSTRACT FROM AUTHOR]