Department Of Pulmonary Medicine Research Articles

A retrospective analysis of adverse drug reaction reported in a tertiary care hospital

Background: The adverse drug reactions (ADRs) reported to pharmacovigilance centre in tertiary care hospital was analysed to find out the incidence and causality.Methods: This was a retrospective study to analyse the ADR reported at pharmacovigilance centre after ethical clearance from Institutional Ethic Committee (IEC). ADR data were analysed and ADRs were categorized as department-wise, system affected and causative drug. The causality of each ADR was assessed by WHO-UMC scale.Results: The majority of patients who had suffered from ADRs were between 19-64 years of age (94.2%) and male patients (58.6%) were affected more than female (41.4%). Pulmonary medicine department has reported highest number of ADR followed by dermatology department. Skin (46.5%) was most affected system followed by gastrointestinal (30.45%), CNS (21.26%), respiratory (9.0%) and remaining systems. Rifampicin (13.79%) shows the largest numbers of ADR followed by zidovudine (13.21%), nevirapine (12.64%) and diclofenac sodium (8.0%). The maximum ADRs reported were probable (94.8%) followed by possible (5.2%).Conclusions: In conclusion, the skin was most affected system followed by gastrointestinal, central nervous and respiratory system. Rifampicin has caused maximum ADRs followed by zidovudine, nevirapine and diclofenac sodium. The causality analyses showed that majority of ADRs were probable (94.8%) while remaining falls in possible (5.2%) category.

Pattern of inflammatory phenotypes using sputum cytology among patients with asthma in a tertiary care centre, Kerala –A prospective cohort study

Background: Asthma is a chronic inflammatory airway disease in which various inflammatory cells play a pivotal role in pathogenesis. Based on the inflammatory cells count in the sputum, various inflammatory phenotypes are identified. The identification of asthma phenotypes has potential clinical significance, as natural history and treatment response differ according to phenotype. Objectives: To find out pattern of inflammatory phenotypes of asthma patients and to compare the level of asthma control after 3 months of optimized treatment in different phenotypes. Methods: We did a hospital based prospective cohort study in the Department of Pulmonary Medicine, Medical College, Thiruvananthapuram, Kerala, over a period of one year. 138 consecutive non-smoker, asthma patients were included. Sputum was examined for differential count. The phenotype was considered eosinophilic if eosinophil count was ≥3% and noneosinophilic if eosinophil count < 3%. Each patient was reassessed after 3 months of optimized treatment and level of asthma control was assessed according to GINA guidelines. Results: 53.6% of study population were in the eosinophilic and 46.4% were in the noneosinophilic phenotype. Mean age of eosinophilic phenotype was 38.4 ± 11.7 years and that of noneosinophilic was 48.8 ± 10.6 years (p<0.001). Mean BMI of eosinophilic asthma patient was 23.3 ± 2.4 and that of noneosinophilic was 24.9 ± 2.3 (p <0.001). Atopic symptoms were present in 73% of the eosinophilic phenotype and 25% of the noneosinophilic phenotype (p<0.001). There was no statistically significant difference between the two phenotypes with regard to the gender, duration of illness, family history of asthma, or initial severity of the disease. After 3 months of optimized treatment, in eosinophilic phenotype 73% of patients became controlled or partially controlled. In noneosinophilic group only 46.9% became controlled or partially controlled (p= 0.002).Conclusion: Noneosinophilic asthma occured in older, obese patients, were usually non atopic and had poor asthma control after three months optimized treatment, compared to eosinophilic phenotype. Thus phenotypic classification could help to guide clinical decisions in personalized medicine approach.

PULMONARY ALVEOLAR MICROLITHIASIS: CLINICAL AND RADIOPATHOLOGICAL REVIEW.

30Mar 2017 PULMONARY ALVEOLAR MICROLITHIASIS: CLINICAL AND RADIOPATHOLOGICAL REVIEW. Tushar Sahasrabudhe and Sowmya Attipatla. Department of Pulmonary medicine, Dr. D.Y.Patil Medical college and Research institute, Pimpri, Pune.

Role of CB-NAAT in diagnosing Mycobacterial tuberculosis and rifampicin resistance in tubercular peripheral lymphadenopathy

Introduction: Diagnosis of Extra Pulmonary TB (EPTB) remains a challenge. This study assessed the applicability of CB-NAAT in early diagnosis of EPTB, especially peripheral lymphadenopathy and early identification of MDR-TB in TB lymphadenopathy. Material &amp; Method: This was a prospective, cross sectional study, carried out on all patients of age group 10 to 80 years, who were suspected cases of tubercular peripheral lymphadenopathy, visiting the OPD of the Department of Pulmonary Medicine, People’s Hospital, Bhopal, over a period of 1 year 6 months. FNA of peripheral lymph nodes of 57 patients was sent for cytology and CB-NAAT. Result: This study showed that statistical difference in diagnostic yield of FNAC (47/57 i.e. 82.4%) and CB-NAAT (44/57 i.e. 77.19%) in tubercular peripheral lymphnode sample was not significant. This implies that there was not much difference in these two test results. There was no rifampicin resistance in the population studied. Conclusion: CB-NAAT did not diagnose more cases of TB-LN than FNAC.

Obstructive sleep apnoea in children –a neglected entity

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Obstructive sleep apnoea syndrome (OSAS) is a spectrum which includes primary snoring, upper airway resistance syndrome, obstructive hypoventilation and obstructive sleep apnoea. Sleep disordered breathing (SDB) is characterized by snoring, witnessed apnoea, frequent arousal, mouth breathing, restless sleep, irritability, recurrent upper respiratory tract infections etc. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This was a prospective observational study which included 20 children who presented to the otorhinolaryngology, pulmonary medicine, paediatric, oral and maxillofacial department were included in the study with clinical symptoms of obstructive sleep apnoea. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 20 children, 13 (65%) males and 7 (35%) females were included. Snoring was the most common complaint.15 (75%) were obese, 5 had adenotonsillar hypertrophy(25%) as the risk factor for OSA. 15 out of the 20 children were graded under mallampati class 1(75%), 4 class 2(20%), 1under class 3(5%). There was no significant association in severity of OSA between 2 genders (p=0.82). &lt;span lang="EN-IN"&gt;Positive correlation (r=0.52) was found between AHI and BMI and is found to be statistically significant (p=0.02), which suggests that degree of obesity does predict the severity of OSA. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Obesity is the most significant risk factor among them followed by adenotonsillar hypertrophy. Hence children who snore should undergo polysomnography and necessary corrective measures should be prescribed.&lt;/span&gt;&lt;/p&gt;

A study of adverse drug reactions among pulmonary tuberculosis patients treated under dots in a tertiary care hospital

Background: DOTS under RNTCP is the current treatment available for Pulmonary Tuberculosis. This treatment exhibit a greater level of efficacy with a small degree of toxicity. The present study aims to determine demography of patients with pulmonary tuberculosis and to study the ADRs caused by anti tubercular drugs and to assess the causality and severity of the reported ADRs.Methods: We studied cases of Pulmonary Tuberculosis diagnosed and treated under category I DOTS at Department of Pulmonary Medicine for the period of one year (during 2015). Adverse effects observed during treatment course were recorded in standard ‘Adverse Drug Event Reporting Form’. ADRs were also assessed for their causality and severity by using WHO-UMC criteria and Hartwig’s scale.Results: Pulmonary cases accounted for 67.6% of total TB cases. Among 434 cases of pulmonary tuberculosis 33 (7.6%) patients were defaulters; among them 3(9.5%) cases were defaulters due to ADRs. In our study 96 patients developed 123 ADRs of various types and most of the ADRs noted within first 2 weeks of initiation of treatment. Gastritis was the most common ADRs (28/22.7%) followed by anorexia (26/21.1%).Conclusions: In our study 22.1% of patients developed ADRs. ADRs recorded in our study were categorised under ‘probable’ and ‘possible’ causes and severity assessment showed 48% are moderate and 52% are ‘mild’ in nature. Still ADRs accounted for 9% default rate. Hence implementations of good patient care oriented programs are needed for early diagnosis and to reduce default rate and drug resistance.

Decreasing wait times for endobronchial ultrasound (EBUS).

192 Background: The department of pulmonary medicine evaluates manifestations of cancer and complications of therapy that affect the lungs. It is a procedurally oriented specialty with many diagnostic and therapeutic interventions. Endobronchial ultrasound with transbronchial fine needle aspiration (EBUS-TBNA) is a minimally invasive procedure that allows real time image guided sampling of tissue in the mediastinum. Current guidelines recommend use of EBUS for the initial test to diagnosis and stage lung cancer. It has a low complication rate, but needs specialized equipment as well as anesthesia support. Alternatives include CT-guided biopsy or surgery. The delay from time of referral to EBUS procedure has the potential to delay diagnosis and treatment, create patient anxiety, frustration and expense of travel for multiple appointments. The staff is under pressure to perform excessive cases on a daily basis resulting in overtime staffing costs. Our objectives were to reduce delays in diagnosis/treatment, improve patient satisfaction, improve referring services satisfaction and optimize the use of resources and improve staff working conditions. Methods: We used a Plan, Do, Study, Act process. Initially the process flow diagram was utilized along with a fishbone diagram to allow us to focus on the issues. The aim was to decrease EBUS wait time 20% by 7/2016. Our process flow sheet was arranged into swimlanes in order to identify focus areas. This allowed us to redesign the workflow to improve capacity and improve existing resources to be more efficient. Results: Working with anesthesia services and the cardiopulmonary center staff, we were able to open a second bronchoscopy suite 2 days a week for additional EBUS cases. We also had monthly meetings with issues and to monitor delays to other services. Conclusions: We were able to reduce our wait time from 7.5 days to 4.27 work days. The added capacity allows for surge in demand for EBUS. Our future studies will concentrate on patient and referring service satisfaction, cost savings with reduction in overtime, quantifying impact on decreasing delays in diagnosis and subsequent treatment.

Serum Vitamin D levels in Chronic Obstructive Pulmonary Disease

Introduction: Lower serum 25 (0H) Vitamin D is associated with decreased lung function in healthy population and various lung disease. Information on the relationship of levels of serum 25 (OH) Vitamin D with severity of Chronic Obstructive Pulmonary Disease (COPD) is important in standardizing the treatment, in planning appropriate follow up and improving quality of life. This study also warranted further trial to assess the effect of serum 25 (OH) vitamin D on morbidity and mortality in COPD patients. Material and Methods: It was a prospective (observational), cross-sectional study which included all patients with Chronic Obstructive Pulmonary Disease (COPD) attended the Department of Pulmonary Medicine, People’s College of Medical Sciences &amp; RC, Bhopal, over a period of 1 year 6 months. Results: The mean serum 25 (OH) vitamin D level in COPD patients was 27.86±16.47 ng/ml. There was no significant difference in serum 25 (OH) vitamin D between patients in different age groups. The serum 25 (OH) vitamin D levels varied significantly between different GOLD stages and different mMRC dyspnea grades. The patient who had a history of admission for twice or more in the past 1 year had a lower mean serum 25 (OH) vitamin D level as compared to patient with just one or no hospitalization in the past. Conclusion: Decrease serum 25(0H) vitamin D levels were associated with increase airway obstruction.

A retrospective study on drug utilization in patients with acute exacerbation of bronchial asthma in adults at tertiary teaching hospital in Bidar

Background: Drug utilization plays a role in helping the health care system to understand, interpret and improve the drug use and continuous quality improvement. It plays an essential part of pharmaco Epidemiological studies.Methods: 100 prescriptions from patients with established diagnosis of acute exacerbation of Bronchial asthma were assessed from the Department of Pulmonary Medicine and the data gathered was analysed using MS Excel.Results: Majority of the prescriptions irrespective of severity received inhalation β2 agonist (formoterol) as a bronchodilator. Nebulization route was given for managing the acute exacerbations followed by inhalation route. Hydrocortisone was prescribed to all patients for managing acute Exacerbations. Montelukast was used an adjuvant therapy. Most of them were prescribed combination therapy. Theophylline was prescribed among all the methylxanthines.Conclusions: β2 agonists Combinations and corticosteroids are the most commonly prescribed combination drugs for asthma followed by methylxanthines. The most commonly prescribed asthmatic Medication in combination therapy was inhaled salbutamol with ipratropium followed by intravenous Hydrocortisone and oral Montelukast. The most commonly prescribed methylxanthine was intravenous Theophylline. Nebulization was preferred route to tackle the acute exacerbation of asthmatic symptoms.

Palliative Care in the ICU: A Qualitative Study of MICU Physicians’ Beliefs & Practices (S702)

•Delineate the models by which palliative care (PC) may be provided for medical ICU (MICU) patients.•Describe services provided by PC physicians that critical care (CC) physicians find particularly helpful.•Appreciate that many CC physicians gain satisfaction from providing PC for their patients, and so understand the value of educating and supporting CC physicians in providing PC. Despite the recent growth of palliative care (PC) as a specialty, there remains a relative shortage of PC professionals. In medical intensive care units (MICUs) both PC and critical care (CC) physicians are needed to meet the need for PC. We aimed to explore MICU physicians’ beliefs and practices regarding PC. This analysis reports MICU physician’s beliefs about providing PC, the role that they attribute to the PC team, and their motivations for initiating a PC consultation. Seventeen of the 53 physicians within a Department of Allergy, Pulmonary, and Critical Care Medicine took part in semi-structured interviews, which were conducted, transcribed and coded according to qualitative research methods. Four code-rich interviews were tested for inter-rater reliability, and 96% agreeability was reached through negotiated agreement. All CC physician participants stated that PC was a part of their job, and 9 out of 17 expressed gaining professional identity or personal satisfaction from providing PC. Participants identified many activities performed by PC consultants that were helpful to the CC team. They also described a variety of motivations for seeking a consult, some of which were unrelated to the specific expertise of a PC clinician. This study provides a baseline understanding of the PC provided by MICU physicians and when a PC consulting team may be most helpful in one academic medical center. It also provides support for developing an appropriate balance of primary and secondary palliative care, as it is likely to support physicians’ job satisfaction as well as optimal patient care.

Prevalence and etiological profile of chronic obstructive pulmonary disease in nonsmokers.

Background:Tobacco smoking has been recognized as the most important risk factor for chronic obstructive pulmonary disease (COPD) for a long time, but recent studies have shown that nonsmokers also contribute to a significant proportion of COPD. This study was performed to find out the proportion of nonsmoker individuals among COPD patients and to determine various etiologies in nonsmoker COPD patients.Materials and Methods:This study was an observational cross-sectional study conducted in Department of Pulmonary Medicine, MLN Medical College, Allahabad. A total of 200 COPD patients, aged >18 years of either gender with COPD, diagnosed by clinical and spirometric criteria (GOLD guideline) were included in the study.Results:Of the 200 COPD patients, the proportion of nonsmoker patients was 56.5%, and the smoker was 43.5%. Among 113 nonsmoker COPD patients, maximum number of patients (69.03%) belonged to low socioeconomic status but most important and statistically significant risk factor was exposure to biomass smoke (53.98%), other significant risk factors were treated pulmonary tuberculosis (32.74%), and long-standing asthma (14.16%). Risk factors that were not statistically significant were occupational exposure (9.73%), exposure to outdoor air pollution (3.54%), and lower respiratory tract infection during childhood (1.77%). The patients who were exposed to more than one risk factors, developed COPD at an earlier age.Conclusions:This study revealed that nonsmokers contribute a significant proportion of COPD patients. Multiple risk factors other than smoking also play a major role in the development of COPD, particularly exposure to biomass smoke, treated pulmonary tuberculosis, and long-standing asthma.

Assessment of significance of Yoga on quality of life in asthma patients: A randomized controlled study.

Background:Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath and a tight feeling in the chest. The current study is based on the effect of Yoga on quality of life in asthmatics in Northern India.Materials and Methods:A total of 300 participants of mild-to-moderate persistent asthma (FEV1 >60%) aged between 12 and 60 years were recruited from the Department of Pulmonary Medicine. Their quality of life was assessed with the help of mini asthma quality-of-life questionnaire (AQLQ) at baseline and then after 3rd and 6th month from baseline. Forty-five participants were dropped out during the study while 255 participants completed the study successfully.Results:In “the Yoga group,” significant improvements were found in all the subdomains of AQLQ at 3rd month and at 6th month in comparison to “the control group.” The number needed to treat was found to be 2.67 for the total AQLQ score which was greater than the minimal important difference.Conclusion:“The Yoga group” got significantly better improvement in asthma quality-of-life scores than “the control group.” Thus, Yoga can be used as an adjuvant therapy in the management of asthma.

Prevalence of osteoporosis and osteopenia in stable patients of chronic obstructive pulmonary disease in Sub-Himalayan region of Himachal Pradesh, India.

Background:Chronic obstructive pulmonary disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease and a major cause of morbidity and mortality globally. Osteoporosis and osteopenia are common observations in COPD and degree of the loss of bone mineral density (BMD) has been found to be proportionate to the severity of the disease.Objectives:Our objective was to study the prevalence of osteoporosis and osteopenia in stable COPD patients in Indian Sub-Himalayan population.Materials and Methods:This study was performed on 84 patients of COPD attending as outpatient in the Pulmonary Medicine Department after application of inclusion and exclusion criteria. A control group of 60 healthy controls was selected for comparison with COPD group. Spirometry was done on patients to stage the severity of COPD according to global initiative for chronic obstructive lung disease criteria. Dual-energy X-ray absorptiometry scan of the lumbar spine was done using bone densitometer to determine the severity of reduced BMD. The patients were categorized according to the World Health Organization criterion for definition of reduced BMD.Results:In the present study, a total of 45.2% patients had osteoporosis, 41.6% patients had osteopenia while the rest 13% patients had normal bone density in the COPD group. The prevalence of low bone density was about 4 times higher in COPD group as compared to control group. There were 15.48 times higher chances of low BMD in COPD patients as compared to healthy controls.Conclusions:Reduced BMD is a common comorbid entity in COPD patients which leads to increase in bone fragility and susceptibility to fracture. It is recommended that all the patients with COPD should be screened for osteoporosis to initiate the treatment for the disorder before they develop fractures.

Experiences of Living with Dyspnea Among Taiwanese People with Chronic Obstructive Pulmonary Disease: A Qualitative Study

Purpose: Dyspnea is the primary complaint among patients with chronic obstructive pulmonary disease (COPD) and is a subjective physical experience responsible for considerable distress in patients. However, to date, research has tended to focus on measuring the severity of dyspnea, with few studies considering the subjective experiences among people living with COPD. The current study explored the experiences of living with dyspnea among patients with COPD. Methods: In this qualitative descriptive study, we examined 12 purposively sampled outpatients with COPD from the Pulmonary Medicine Department. One-on-one in-depth interviews were conducted to collect information. Data reduction, data display and conclusion drawing that three-step method was adopted to analyze the data. Results: Based on interview data analysis, 6 themes were devised regarding the dyspnea experiences of participants: (a) internal urgent situation signal resulting from a life-threatening incapability to respire; (b) triggering and straining; (c) constraints in life caused by insufficient inhalation; (d) immediate self-rescue strategies; (e) awareness of maintain health in daily life; and (f) coexistence with the disease and redefine self-concept. Conclusions: As COPD progresses, people living with COPD experienced discomfort and developed self-rescue strategies by identifying the risk factors for dyspnea as well as measures for symptom deterioration. Most participants experienced loss of activity or physical functions in their daily lives, prompting them to begin reposition themselves. To maintain the existing functions of the patients is the main goal for both medical staffs and patients. The findings of this study can serve as a reference for medical teams to devise self-management plans for patients with COPD.

Osteoporosis in COPD: Are Bones Brittle in COPD?

Chronic obstructive pulmonary disease COPD is a systemic disease with predominant respiratory symptoms. Airflow obstruction has significant effects on cardiac function and gas exchange with systemic consequences. Various extra pulmonary effects include, Skeletal muscle wasting and cachexia, ischemic heart disease, heart failure including left sided heart failure, osteoporosis, Normocytic anemia, lung cancer, depression etc. Osteoporosis becomes more prevalent in COPD patients as the disease progresses. Present study is a case-control study that was conducted by department of Internal and pulmonary medicine. Patients diagnosed with COPD based on ATS guidelines and staged based on GOLD guidelines that were following as an outpatient in pulmonary clinic of SKIMS were selected for the study. Total of sixty patients of COPD were taken and were compared with one hundred twenty age and sex matched controls. In current study we found no significant correlation between osteoporosis and smoking, although smoking is clearly a risk factor for both osteoporosis and COPD.

Assessment of Depression and Anxiety in Chronic Obstructive Pulmonary Disease Patients attending Pulmonary Medicine Department of Rohilkhand Medical College &amp; Hospital, Bareilly, Uttar Pradesh, India

ABSTRACT Introduction Chronic disease like chronic obstructive pulmonary disease (COPD) is associated with various comorbidities. Anxiety and depression are among the common comorbidities and have significant impact on socioeconomic status of the person as well as the course of disease. In our study, we screened COPD patients attending the outpatient department (OPD) of pulmonary medicine for anxiety and depression, using different scales that include questionnaires. About 46.2 and 34.6% cases were found to have depression and anxiety respectively, among all COPD patients (n = 156). Incidence of anxiety and depression was directly proportional to severity of disease. Age, gender, locality, educational, marital, and socioeconomic statuses are some factors that play important roles in the development of these psychiatric comorbidities. Hence, mental assessment of COPD patients should be mandatory with every visit to the OPD. How to cite this article Jaiswal A, Kumar A, Rathi H, Sharma CS, Sharma P, Arya V. Assessment of Depression and Anxiety in Chronic Obstructive Pulmonary Disease Patients attending Pulmonary Medicine Department of Rohilkhand Medical College &amp; Hospital, Bareilly, Uttar Pradesh, India. Int J Adv Integ Med Sci 2017;2(3):137-139.

P1.01-058 Demographic Profile of Lung Cancer from Eastern India

The clinico-pathological profile of primary lung cancer has changed considerably over the last few decades in India. Available literature suggests that the features of lung cancer in India like prevalence, incidence, aetio-pathogenesis and presentation vary markedly from the west. We performed a prospective evaluation of the unique demographic features of lung cancer with specific emphasis on smoking and histopathological trends. We analyzed all pathologically proven lung cancer cases registered over a period of initial 30 months in the department of Pulmonary Medicine of this All India Institute of Medical Sciences, Bhubaneswar. The patients were evaluated for their epidemiological, clinical and pathological profiles. The data were recorded in MS Excel spreadsheets and subjected to appropriate statistical analysis. Data was collected directly from patients’ paper and electronic medical records. All patients of histologically proven lung cancer were included. A total of 179 patients were included in the database of which 6 patients were excluded for significant missing data. There were 114 male and 59 women) average age 57.24 with a M:F ratio of 1.93 :1. Over half (56%) of the patients were active or past smokers, while 48% patients had not been exposed to active or passive smoking. Bidi (tobacco flake wrapped in tendu leaf) smoking was more common (37%) than cigarettes (19%) while 9% smoked both. Exclusive chewed tobacco use was seen in 12% while combined use of chewed and smoked tobacco was seen in 4% patients. The proportion of women never-smokers with lung cancer was significantly higher (89%) compared to men (28%). More than two-thirds patients (69.8%) presented with metastatic disease. Amongst patients with a definitive cytohistological diagnosis, the prevalence of adenocarcinomas was highest (56.3%) followed by squamous (30.8%), small cell (8%) and NSCLC NOS (4.9%). Adenocarcinoma is the commonest histological subtype in this region. Prevalence of lung cancer among non-smokers is also high in the eastern part of India. The demographic profile of patients with lung cancer in eastern India is unique with a much higher proportion of tobacco chewers and non-smoker especially in women. There is significant epidemiological trends towards a predominant adenocarcinoma histology. Most of the patients present at an advanced stage, probably due to lack of awareness and limited diagnostic resources in this part of the country. Although there are direct associations with smoking, there has been an increase in the non-smoking lung cancers worldwide.

P2.01-011 Identification of Differentially Expressed Circulating miRNAs in the Serum of NSCLC Patients Using next Generation Sequencing

Aberrant expression of miRNAs has been found in human cancers and has not only been used as diagnostic, prognostic, and predictive biomarkers, but also as potential therapeutic target. In this study, we compared the expression profile of miRNAs in the serum of NSCLC patients with that of non-malignant respiratory disease patients and healthy controls. For this prospective pilot study, a total of 10 subjects were recruited, 2 each of lung adenocarcinoma (ADC), squamous cell carcinoma (SQC), pulmonary tuberculosis (TB), chronic obstructive pulmonary disease (COPD), and healthy controls, from Outpatient Department of Pulmonary Medicine and Sleep Disorders, AIIMS, New Delhi. Approximately 5 ml. of peripheral blood was collected; serum was separated and total RNA was isolated using miRNeasy serum/plasma kit (QIAGEN). Small RNAs were purified from total RNA; libraries of 18 to 50 nt small RNAs were prepared with the TruSeq RNA Library Prep Kit (Illumina), and mature miRNAs were profiled using illumina TruSeq Sequencing Chemistry on illumina HiSeq 2000 next generation sequencing (NGS) platform. Quality check was performed and high quality raw data was mapped on to miRBase database. The expression profile of miRNAs in each subject was analyzed using miRNAkey software and fold change was performed to identify differentially expressed miRNAs in NSCLC as compared to controls. Using NGS, we were able to detect 1074, 1013, 299, 268, and 907 known miRNAs in the serum of lung ADC, SQC, TB, COPD and healthy controls, respectively. A number of miRNAs, such as let-7, miR-10b-5p, miR-15a-5p, miR-23b-5p, miR-92a-3p, miR-148b-3p, miR-185-3p, miR-192-5p, miR-320a, miR-329-3p, miR-342-3p, miR-375, miR-449a, miR-486-5p, miR-497-5p, miR-584-3p, miR-1908-5p, and miR-3195 were found to be downregulated, while miR-10a-5p, miR-148a-3p, and miR-197-3p were found to be upregulated in NSCLC as compared to non-malignant respiratory disease controls and healthy controls (>2 fold change; p<0.05). Further, few miRs, including miR-93-3p, miR-130b-5p, miR-196b-5p, miR-337-3p, miR-378f, miR-382-5p, miR-424-3p, and miR-1271-3p were found to be specifically expressed in NSCLC. A number of miRNAs were found to be dysregulated in the serum of NSCLC patients than controls. The present study is being continued in a larger set of subjects to validate the findings & also the expression patterns of target genes of differentially expressed miRNAs is being analyzed by real-time reverse-transcriptase PCR to find their relevance in lung carcinogenesis. This may prove to be useful for developing non-invasive diagnostic and prognostic tools as well as tools to monitor therapeutic efficacy in NSCLC.

Occurrence of Anxiety and Depression among Stable COPD Patients and its Impact on Functional Capability.

Anxiety and depression are important but often under-diagnosed co-morbid conditions in patients with Chronic Obstructive Pulmonary Disease (COPD) which may affect the functional capacity of the patients. To find out the proportion of depression and anxiety among stable COPD patients using a validated questionnaire suitable for use in clinic and the factors affecting their reduced functional capability as assessed by six-minute walk test. This was a descriptive cross-sectional study. Seventy five patients diagnosed with stable COPD in outpatient Department of Pulmonary Medicine in a tertiary care hospital, satisfying all inclusion criteria, were included in the study. They were examined clinically, categorized as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity assessment guideline and interviewed by designated interviewer using validated questionnaire for depression (Hamilton depression rating scale, HAM-D) and anxiety (State Trait Anxiety Inventory, STAI). The functional exercise capacity of the patient was assessed by six-minute walk test. Statistical analysis was performed using Minitab software (version16.1). Among 75 stable COPD patients (68 male, 7 female), majority (32 out of 75) had both depression and anxiety, while only anxiety or depression was present in 9 each. The patients with depression had no significant difference in six-minute walk distance, change in heart rate and respiratory rate (p = 0.4186, 0.219 and 0.41 respectively) as compared to those without depression, but were found to be more dyspnoeic at the end of the test (p= 0.003). There was also no significant difference in walk distance in patients with high STAI score as compared to those with low STAI score (p= 0.276). Both anxiety and depression were present in majority of the stable COPD patients. The presence of these co-morbid conditions had no significant effect on the functional status of the patients in the form of reduced six-minute walk distance, though they were more symptomatic than those without these co-morbidities.

Prevalence of Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma at a tertiary care center in North India.

Background:The prevalence of Aspergillus hypersensitivity (AH) and allergic bronchopulmonary aspergillosis (ABPA) has been variably reported. Systematic data regarding Aspergillus sensitization and ABPA are lacking from this part of the country.Objectives:The aim of this study was to evaluate the prevalence of AH and ABPA in Uttar Pradesh.Setting and Design:This was prospective observational study. All patients attending outpatient Department of Pulmonary Medicine of our institute were included in the study.Subjects and Methods:Consecutive asthmatic patients underwent screening for ABPA using Aspergillus skin test (AST). Those showing a positive response to AST were further evaluated for ABPA.Results:During the study, 350 patients (192 males, 158 females, mean ± standard deviation age: 38.3 ± 12.8) were screened with AST. One hundred and twenty-three patients (35.1%) were tested positive for AST and 21.7% of patients were diagnosed as ABPA.Conclusions:A high prevalence rate of ABPA was observed at our chest clinic. Although comparable with published data from other tertiary centers, it does not represent the true prevalence rates in asthmatics because of high chances of referral bias.