Department Of Respiratory Medicine Research Articles

Factors associated with treatment outcome of multidrug-resistant tuberculosis patients co-infected with human immunodeficiency virus in a Drug Resistant Tuberculosis Centre

Background: Tuberculosis is one of the major public health problem, further complicated by the relentless spread of human immunodeficiency virus (HIV). The incidence of drug resistant TB among HIV patients is now increasing. Treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients co-infected with HIV is poorly documented. Objectives: Assessed the treatment outcome of MDR-TB co-infected with HIV treated under programmatic management of drug resistant tuberculosis. Methods: The study was conducted in Department of Respiratory Medicine, Princess Krishnajammanni Tuberculosis and Chest Diseases (PK TB & CD) Hospital, Mysore Medical College and Research Institute (MMCRI), Mysore. It is a retrospective study done on patients who were admitted in DRTB center of PK TB & CD hospital, Mysore for initiation of treatment from January 2013 to December 2019. Results: Among the 63 patients studied, 26 patients (41.3%) had a favorable outcome with cure and treatment completed. 25 patients (39.7%) had an unfavorable outcome with death, 9 patients (14.3%) defaulted during the treatment and 2 patients (3.2%) had failure of therapy. Conclusion: Early recognition and treatment of HIV with ART and the clinical stage of the disease during presentation affect the treatment outcome in patients with MDR-TB. Keywords: tuberculosis; HIV; outcome; multidrug resistance; ART

English

BACKGROUND The global wide adoption of telemedicine provided a considerable and long-lasting influence in healthcare but was not firmly established in a catastrophic situation like the COVID-19 pandemic. Hence, the purpose of this study was to enlighten the efficacy of telemedicine and its competence in treating mild COVID-19 patients in a home isolation setup. METHODS 200 patients were enrolled for the COVID Tele home Care Services initiated by the Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research Institute (SRIHER), Chennai, India from August 2020- November 2020. All the enrolled patients were RT-PCR confirmed COVID 19 with mild severity and were virtually telemonitored and treated by video and audio calls. Measures such as age, sex, present clinical complaints, existing co-morbidities, blood investigations, oxygen saturation (Spo2), and radiological investigations were detailed at the time of enrolment and discharge. Statistical analyses with SPSS version 19 were executed to determine the p-value significance (P < 0.05). RESULTS Among the 200 patients enrolled for this study, 167 patients were symptomatic and 33 were asymptomatic. 77 % of the patients had symptom resolution within 1 week and the remaining 23 % were monitored for up to 14 days. Out of 195 patients discharged from home care, only 5 required hospitalization because of persisting symptoms like fever, vomiting, deranged blood parameters and desaturation. CONCLUSIONS Telemonitoring of mild COVID-19 patients under a specialist team including pulmonologists, nursing, paramedics, nutritionist, and psychologist is found to be a safe, reliable, and competent model in such pandemics. KEY WORDS COVID-19, Healthcare System, Pandemic, Telemedicine, Telemonitoring.

Neutrophil side fluorescence: a new indicator for predicting the severity of patients with bronchiectasis

BackgroundNeutrophilic inflammation in the airway is a hallmark of bronchiectasis. Neutrophil extracellular traps (NETs) have been reported to play an important role in the occurrence and development of bronchiectasis. Neutrophil side fluorescence is one of the characteristics of neutrophils that can reflect the activation of neutrophils and the formation of NETs.ObjectiveTo explore the relationship between the values of neutrophil side fluorescence (NEUT-SFL) in the peripheral blood of bronchiectasis patients, and the severity of the disease.Methods82 patients with bronchiectasis from the Department of Respiratory and Critical Medicine, at the Third Affiliated Hospital of Southern Medical University and were scored with Bronchiectasis Severity Index (BSI) (2019–2021). The clinical data such as the value of NEUT-SFL, neutrophil count, C-reactive protein, and procalcitonin levels were collected and retrospectively analyzed. NEUT-SFL values neutrophil count from 28 healthy subjects were also used to ascertain cut-off values.ResultsBased on the BSI scores, patients were divided into three categories as mild (32%), moderate (29%), and severe (39%). Our results showed that the values of NEUT-SFL were higher in bronchiectasis patients compared to healthy controls. The levels of NEUT-SFL positively correlated with the high BSI scores in patients (P = 0.037, r = 0.23) and negatively correlated with the lung function in these patients (r = − 0.35, P = 0.001). The area under the ROC curve was 0.813, the best cut-off was 42.145, indicating that NEUT-SFL values > 42.145 can potentially predict the severity of bronchiectasis.ConclusionsThe values of NEUT-SFL in the peripheral blood can be used for predicting the severity of bronchiectasis.

Incidence of Chronic Pulmonary Aspergillosis in Patients with Suspected or Confirmed NTM and TB-A Population-Based Retrospective Cohort Study.

Chronic pulmonary aspergillosis (CPA) is a severe and underdiagnosed pulmonary fungal infection with a significant overlap in symptoms and imaging findings of mycobacterium tuberculosis (TB) and non-tuberculous mycobacterium (NTM). Infection with TB or NTM is a predisposing underlying condition for CPA in approximately one-third of patients. A previously published study from Uganda showed increased incidence and complication rate of CPA with respect to pre-existing radiographic cavitation in a post-treatment TB population. The aim of this study was to investigate the incidence of CPA in a low-endemic population of confirmed or suspected TB and NTM patients. We manually reviewed 172 patients referred on suspicion or for treatment of TB or NTM at the Department of Respiratory Medicine, Odense University Hospital during the period of 1 January 2018 to 31 December 2020. We found no CPA amongst TB patients as opposed to an incidence of 8.2% (n = 4) in NTM-infected patients. We identified possible investigatory differences in Aspergillus blood sample screening protocols depending on NTM or TB, initiated at the Department of Respiratory Medicine at Odense University Hospital. A focused screening and investigatory protocol in NTM patients with persisting or developing symptoms is warranted in relation to suspected CPA.

Presumed Latent Tuberculosis-related Intermediate Uveitis Manifesting as Recurrent Vitreous Hemorrhage

Purpose: We report a case of recurrent vitreous hemorrhage in a patient with presumed latent tuberculosis-related intermediate uveitis, and we review the literature.Case summary: A 58-year-old male visited our clinic complaining of ocular pain, conjunctival hyperemia, decreased vision, and uncontrolled intraocular pressure (IOP) in the left eye. The best-corrected visual acuity (BCVA) was 0.4 and the IOP of the left eye was 34 mmHg. Slit lamp examination revealed conjunctival hyperemia, corneal edema, and inflammatory cells in the anterior chamber and anterior vitreous; fundus examination revealed mild vitreous opacity attributable to vitritis. The high IOP and the intraocular inflammation were treated with antiglaucoma agents and corticosteroids under the impression of chronic anterior uveitis and uveitic glaucoma. Of the tests performed to identify the cause of the uveitis-related vitreous hemorrhage, the interferon-gamma release assay was positive. A presumptive diagnosis of latent tuberculosis-related uveitis was made after pulmonary tuberculosis was excluded by our respiratory internal medicine department. Isoniazid was administered for 9 months. The vitreous hemorrhage recurred 1 month after antituberculosis therapy commenced but, at 2 months, all of the hemorrhage was absorbed and the BCVA improved to 1.0 without further recurrence.Conclusions: Intraocular tuberculosis can present with various clinical manifestations. If tuberculosis-related uveitis is presumed, tests for latent and manifest tuberculosis should be scheduled to allow of early diagnosis and immediate antituberculosis therapy.

Application of Performance Appraisal in Nursing Management of Respiratory Medicine Department

Application of Performance Appraisal in Nursing Management of Respiratory Medicine Department

Systemic evaluation of cutaneous sarcoidosis: 15-year dermatology experience at University Hospital Limerick.

Sarcoidosis is a multisystem granulomatous disease that can affect almost any organ including the skin, liver, ocular, cardiac, renal, nervous, musculoskeletal and endocrine systems. Systemic evaluation is indicated in all patients diagnosed with cutaneous sarcoidosis, as it is associated with asymptomatic systemic disease in 30%-40% of patients. Guidelines recommend that patients diagnosed with sarcoidosis undergo baseline and surveillance investigations including full blood count (FBC), renal and liver profile, Vitamin D, serum calcium, electrocardiography (ECG), chest radiography, pulmonary function tests (PFTs) and ophthalmology examination to assess for systemic involvement. Recommendations for surveillance monitoring vary on interval duration but include regular FBC, biochemistry, chest radiography and PFTs, with additional investigations and prompt referral to respective specialties as indicated.. We conducted a retrospective analysis to evaluate extracutaneous involvement and systemic evaluation of patients diagnosed with cutaneous sarcoidosis during the period 2004-2020, and compared our findings with international guidelines. Cutaneous manifestation was the primary presentation for 67% of the patients (12 of 18), an extracutaneous disease subsequently developed in 67% (8 of 12) of these patients. Baseline investigations included chest radiography (94%; 17 of 18), PFTs (39%; 7 of 18), FBC (94% (17 of 18), renal profile (89%; 16 of 18), liver function tests (83%; 15 of 18) and serum calcium (89%; 16 of 18); ECG was performed for 4 (25%) of 16 patients. No Vitamin D levels were recorded. Specialist referral was required for 89% (16 of 18); of these 16 patients, 94% (15 of 16) required referral to the Respiratory Medicine department, 69% (11 of 16) to Ophthalmology and 19% (3 of 16) to Nephrology. The results highlight the importance of a structured protocol for the systemic evaluation of patients diagnosed with cutaneous sarcoidosis. We subsequently developed a baseline and surveillance protocol for the assessment of extracutaneous disease in patients at University Hospital Limerick.

Impact of Upper Airway Characteristics on Disease Severity and CPAP Therapy in Chinese Patients With OSA: An Observational Retrospective Study.

ObjectiveThe characteristics of the upper airway (UA) are important for the evaluation and treatment of obstructive sleep apnea (OSA). This study aimed to investigate the association of UA characteristics with OSA severity, titration pressure, and initiation of and 3-month compliance with continuous positive airway pressure (CPAP).MethodsThis retrospective study included consecutive patients examined using a semi-quantitative UA evaluation system (combination with physical examination and awake endoscopy) during 2008–2018 at the Department of Respiratory and Critical Care Medicine, Peking University First Hospital. First, the differences in UA characteristics were compared between patients with simple snorers and mild OSA and those with moderate-to-severe OSA. Then, the effect of UA characteristics on the initiation to CPAP therapy and 3-month adherence to CPAP was conducted.ResultsOverall, 1,002 patients were included, including 276 simple snorers and patients in the mild OSA group [apnea-hypopnea index (AHI) <15] and 726 patients in the moderate-to-severe OSA group (AHI ≥15). Tongue base hypertrophy, tonsillar hypertrophy, mandibular recession, neck circumstance, and body mass index (BMI) were independent risk factors for moderate-to-severe OSA. Among those patients, 119 patients underwent CPAP titration in the sleep lab. The CPAP pressures in patients with thick and long uvulas, tonsillar hypertrophy, lateral pharyngeal wall stenosis, and tongue hypertrophy were higher than those of the control group (P < 0.05, respectively). The logistic regression analysis showed that nasal turbinate hypertrophy, mandibular retrusion, and positive Müller maneuver in the retropalate and retroglottal regions were independent predictors for the initiation of home CPAP treatment.ConclusionMultisite narrowing and function collapse of the UA are important factors affecting OSA severity, CPAP titration pressure, and the initiation of home CPAP therapy. Clinical evaluation with awake endoscopy is a safe and effective way for the assessment of patients with OSA in internal medicine.

Objective structured clinical examinations (OSCEs) for students’ training and assessment in the French respiratory medicine departments in 2021: An overview

BackgroundMedical professional performances can be assessed by objective structured clinical examinations (OSCEs) where medical trainees go through a series of simulated clinical situations. OSCEs are now the gold standard for the assessment of medical students’ competence during their training. In France, the first national OSCEs will take place in May 2024 and respiratory teachers will be involved in this reform and will use OSCEs for students’ training and assessment in respiratory medicine. Students training regarding this final OSCE may vary across medical faculties and may impact students' results. Therefore, we aimed to provide a national overview of OSCE's training performed by respiratory teachers and their interest in developing a common French databank of OSCEs. MethodsWe conducted a national anonymous online survey among the members of the French college of respiratory teachers (CEP), from 2021 February the 15th to 2021 June the 15th. The survey consisted of 32 questions. ResultsAmong 118 French pulmonologists teachers, 52 (45%) responded to the survey. We received a response from at least one of each of the French Medical Universities. Twenty-two (42%) had received specific training on how to conduct an OSCE. Twenty-eight (54%) of respondents used OSCEs for training purposes and 24 (46%) for assessment purposes, for less than 1 year in more than half of the participants. The average satisfaction scores out of 10 about OSCEs was 7.3 ± 1.7 for training and 7.4 ± 1.5 for students’ assessment. Respondents were willing (8.9 ± 1.8 out of ten) to develop a common databank to share OSCEs subjects in respiratory medicine in France. ConclusionsThis survey confirms heterogeneity in the training and the use of OSCEs among French respiratory teachers. However, a common national databank could be a useful tool to reduce these disparities.

The Relation of Brinkman Index and Body Mass Index with Spirometry Result of Chronic Obstructive Pulmonary Disease (COPD) Outpatients in the Pulmonology and Respiratory Medicine Department of Zainoel Abidin General Hospital

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the major health problems worldwide. Smoking is the main risk factor of the COPD development. Not only COPD has clinical manifestations in the lungs, it also manifest outside lungs called systemic effects.One of systemic effects found in COPD patients is weight loss leading to declining lung function. This study aims to determine the relation of Brinkman Index and Body Mass Index (BMI) with spirometry result of COPD outpatients in RSUDZA.&#x0D; Methods: The study was held in lung outpatients department in RSUDZA Banda Aceh on December 5th until 28th with cross sectional design The sampling method is nonprobability sampling with accidental sampling technique. Respondents consisted of 30 patients who had agreed to informed consent given. Medical record used to obtain Brinkman index, BMI, and spirometry result of the patients.&#x0D; Results: The results of analysis shows majority of respondents are male (83,3%), dominated by 56-65 years age range (40,0%) and had moderate Brinkman Index (46,7%). The majority of respondents (53,3%) had an abnormal BMI (severe underweight (13,3%), underweight (6,7%), overweight (23,3%), and obese (10,0%)) and severe spirometry result (53,3%). The data was analyzed by the Spearman Correlation. With the Spearman Correlation, there was no association between Brinkman Index and spirometry result with p value 0,412 (p value &gt;0,05). Meanwhile, there was an association between the BMI and spirometry result with p value 0,006 (p &lt; 0,05). The strength of the correlation is moderate (rs =-0,488).&#x0D; Conclusion: The lower the BMI, the more severe the spirometry result.&#x0D;

Effectiveness of Indacaterol-Glycopyrronium in preventing COPD exacerbations in comparison to Salmeterol-Fluticasone

COPD exacerbations are complex events usually associated with increased airway inflammation, increased mucus production and marked gas trapping. These changes contribute to increased dyspnoea that is the key symptom of an exacerbation. Inhaled long acting bronchodilators not only control symptoms but also prevent exacerbations of chronic obstructive pulmonary disease (COPD). The purpose of the study was to compare the efficacy between Indacaterol-Glycopyrronium and salmeterol fluticasone (SFC) in preventing COPD exacerbations during 24 weeks of treatment. This randomised active-controlled trial was conducted at Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka involving 200 patients with COPD exacerbations. Patients were randomly divided into two groups; &amp; treated with Indacaterol- Glycopyrronium 110/50 ug o.d. &amp; Salmeterol-Fluticasone (50/500 ug b.i.d.) (SFC) respectively; &amp; follow-up was done after 12 and 24 weeks. The FEV1 was significantly higher at 12 and 24 weeks in the Indacateol- Glycopyrronium group compared with SFC. Statistically significant improvements in peak FVC was observed in Indacaterol- Glycopyrronium when compared to SFC at week 12 and week 24. Our study result showed that Indacaterol-Glycopyrronium was superior to Salmeterol-Fluticasone in terms of prevention and optimal management of COPD exacerbation. BSMMU J 2021; 14(3): 43-49

Performance of different methods for detecting T790M mutation in the plasma of patients with advanced NSCLC after developing resistance to first-generation EGFR-TKIs in a real-world clinical setting.

Several approaches to the detection of T790M mutations in patient plasma or tissue samples have been implemented to date. The present study was designed to assess the ability of different technologies to detect the T790M mutation in plasma samples and to evaluate the relative rates of re-biopsy and subsequent patient management in a clinical setting. Data from patients with advanced NSCLC who visited the Department of Respiratory Medicine of the First Hospital Affiliated to Wenzhou Medical University between December 2014 and July 2018 were retrospectively collected. Following re-biopsy, these patients were evaluated for the presence of the T790M mutation via next-generation sequencing (NGS), amplification refractory mutation system or Roche Cobas z480 (Cobas) analyses of tissue samples. T790M mutation status in tumor tissue samples was calculated as a standard reference used to establish the sensitivity, specificity and concordance of three circulating tumor DNA detection approaches, including NGS, droplet digital PCR (ddPCR) and super amplification refractory mutation system (SuperARMS). Subsequent patient management was also recorded. In total, 287 patients with advanced non-small cell lung cancer were evaluated, of whom 55.4% (159/287) underwent tissue re-biopsy, 76.7% (122/159) underwent sequencing analysis of plasma and/or tissue samples, and 59.0% (72/122) were found to harbor the T790M mutation. The rates of plasma sample T790M detection via NGS, ddPCR and SuperARMS were 60.0, 59.3 and 60.0%, respectively. Only 32 patients with T790M mutations (44.4%, 32/72) were treated with third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), while 19 continued treatment with first-generation TKIs, 13 underwent chemotherapy, 1 switched to treatment with anlotinib, 4 succumbed to pericardial or brain metastases, and 3 were lost to follow-up. Additionally, 2 patients exhibited histological transformation from adenocarcinoma to small cell lung cancer, while 17/97 patients who were evaluated for brain metastases during treatment exhibited intracranial progression. Of these, 8 patients had been treated with osimertinib. In this study of a real-world clinical setting, fewer patients than expected underwent re-biopsy and gene sequencing. Of the tools available for the analysis of plasma samples, NGS exhibited the highest sensitivity and concordance with the results of tissue-based T790M detection strategies. It was additionally found that only a subset of patients harboring the T790M mutation were ultimately treated using third-generation EGFR-TKIs.

Evaluation of Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease.

Background: Pulmonary hypertension (PH) is frequently underdiagnosed and under-evaluated in chronic obstructive pulmonary diseases (COPD) patients. As PH is linked to a high rate of mortality from disease-related complications like cor pulmonale, it is critical to have a unified approach to diagnosing and treating it with the aim of improving the patient's quality of life and prognosis in terms of therapeutic considerations. Early identification of this comorbidity in patients with COPD can lead to early initiation of treatment and better prognostic implications. This study was undertaken with the aim of estimating the prevalence of PH in COPD as well as assessing any statistically significant associations between the severity of PH and the severity of COPD.Methods: This was an observational study undertaken at the Department of Respiratory Medicine, Acharya Vinoba Bhave Rural Hospital (AVBRH) in Wardha, Maharastra, India, from August 2019 to September 2021. A total of 100 patients diagnosed with COPD on the basis of spirometry were evaluated with two-dimensional (2D) echocardiography to screen for echocardiographic signs and evidence of PH and severity staging of PH if present.Results: In our study, out of 100 diagnosed cases of COPD, the prevalence of PH was found to be 40% (40 patients) and amongst these, mild, moderate, and severe PH was seen in 26 patients (26%), nine patients (9%), and five patients (5%), respectively. The frequency of PH in moderate COPD was 25% and in severe COPD was 51.5%.Conclusions: PH was found in almost half the COPD patients in the study. Also, the degree and frequency of PH increased with the increase in COPD severity and this was found to be statistically significant.

MicroRNA-265 Regulates Bone Marrow Mesenchymal Stem Cells Differentiation and Promotes Sepsis Lung Injury Repair via Transforming Growth Factor Beta 1

Our study investigates whether miR-265 regulates the differentiation of rat bone marrow mesenchymal stem cells (BMSCs) into alveolar type II epithelial cells (ATII) through TGF-β1 and promotes lung injury repair in rats with sepsis, thereby inhibiting sepsis progression. 25 patients with sepsis admitted to the Respiratory and Critical Care Medicine Department of the hospital and 17 normal controls were included. TGF-β1 level was measured by ELISA. miR-265 level was measured by qRT-PCR and AT II-related genes and proteins expression was analyzed by western blot and qRT-PCR. miR-265 expression was significantly higher in sepsis patients than normal group. Progenitor BMSCs were long and shuttle-shaped after 1 and 3 days of growth. Cultured MSCs had low expression of the negative antigen CD34 (4.32%) and high expression of the positive antigen CD44 (99.87%). TGF-β1 level was significantly increased with longer induction time, while miR-265 expression was significantly decreased in cell culture medium. miR-265 interference significantly decreased TGF-β1 expression. In conclusion, miR-265 inhibits BMSC differentiation to AT II via regulation of TGF-β1, thereby inhibiting sepsis progression.

Toxic epidermal necrolysis during camrelizumab treatment for esophageal squamous cell carcinoma.

Contact DermatitisEarly View CONTACT POINT Toxic epidermal necrolysis during camrelizumab treatment for esophageal squamous cell carcinoma Yuan Peng, Corresponding Author Yuan Peng pengyuan1127@cqmu.edu.cn orcid.org/0000-0001-9563-9568 Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Department of Respiratory Medicine, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China Correspondence Dr Yuan Peng and Professor Zhenzhou Yang, Department of Cancer Center, The Second Affiliated Hospital of Chongqing Medical University, Tianwen Avenue No.288, Nan’an District, Chongqing, 400010, China. Email: pengyuan1127@cqmu.edu.cn (Yuan Peng) and yangzz@cqmu.edu.cn (Zhenzhou Yang) Contribution: Conceptualization (equal), Data curation (supporting), Formal analysis (lead), Funding acquisition (lead), ​Investigation (supporting), Project administration (equal), Supervision (supporting), Writing - original draft (lead)Search for more papers by this authorQian Yu, Qian Yu Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: Data curation (lead), Methodology (lead), Software (lead)Search for more papers by this authorXiaoyue Zhang, Xiaoyue Zhang Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: Data curation (equal), Funding acquisition (supporting)Search for more papers by this authorChuan Zeng, Chuan Zeng Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: Data curation (equal)Search for more papers by this authorYan Zhou, Yan Zhou Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: Data curation (equal), Resources (lead)Search for more papers by this authorYusheng Huang, Yusheng Huang Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: ​Investigation (equal), Resources (supporting), Supervision (equal)Search for more papers by this authorZhenzhou Yang, Corresponding Author Zhenzhou Yang yangzz@cqmu.edu.cn Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Correspondence Dr Yuan Peng and Professor Zhenzhou Yang, Department of Cancer Center, The Second Affiliated Hospital of Chongqing Medical University, Tianwen Avenue No.288, Nan’an District, Chongqing, 400010, China. Email: pengyuan1127@cqmu.edu.cn (Yuan Peng) and yangzz@cqmu.edu.cn (Zhenzhou Yang) Contribution: Conceptualization (equal), ​Investigation (equal), Project administration (lead), Supervision (equal), Writing - review & editing (lead)Search for more papers by this author Yuan Peng, Corresponding Author Yuan Peng pengyuan1127@cqmu.edu.cn orcid.org/0000-0001-9563-9568 Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Department of Respiratory Medicine, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China Correspondence Dr Yuan Peng and Professor Zhenzhou Yang, Department of Cancer Center, The Second Affiliated Hospital of Chongqing Medical University, Tianwen Avenue No.288, Nan’an District, Chongqing, 400010, China. Email: pengyuan1127@cqmu.edu.cn (Yuan Peng) and yangzz@cqmu.edu.cn (Zhenzhou Yang) Contribution: Conceptualization (equal), Data curation (supporting), Formal analysis (lead), Funding acquisition (lead), ​Investigation (supporting), Project administration (equal), Supervision (supporting), Writing - original draft (lead)Search for more papers by this authorQian Yu, Qian Yu Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: Data curation (lead), Methodology (lead), Software (lead)Search for more papers by this authorXiaoyue Zhang, Xiaoyue Zhang Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: Data curation (equal), Funding acquisition (supporting)Search for more papers by this authorChuan Zeng, Chuan Zeng Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: Data curation (equal)Search for more papers by this authorYan Zhou, Yan Zhou Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: Data curation (equal), Resources (lead)Search for more papers by this authorYusheng Huang, Yusheng Huang Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Contribution: ​Investigation (equal), Resources (supporting), Supervision (equal)Search for more papers by this authorZhenzhou Yang, Corresponding Author Zhenzhou Yang yangzz@cqmu.edu.cn Department of Cancer Center, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China Correspondence Dr Yuan Peng and Professor Zhenzhou Yang, Department of Cancer Center, The Second Affiliated Hospital of Chongqing Medical University, Tianwen Avenue No.288, Nan’an District, Chongqing, 400010, China. Email: pengyuan1127@cqmu.edu.cn (Yuan Peng) and yangzz@cqmu.edu.cn (Zhenzhou Yang) Contribution: Conceptualization (equal), ​Investigation (equal), Project administration (lead), Supervision (equal), Writing - review & editing (lead)Search for more papers by this author First published: 04 January 2022 https://doi.org/10.1111/cod.14038 Yuan Peng and Qian Yu contributed equally to this article. Funding information: CSCO Oncology Research Fund, Grant/Award Number: Y-2019AZQN-0444; National Natural Science Foundation of China, Grant/Award Number: 81802984; Natural Science Foundation of Chongqing, Grant/Award Number: cstc2020jcyj-msxmX0208 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

The Diagnostic Role of Uric Acid to Creatinine Ratio for the Identification of Patients with Adverse Pulmonary Embolism Outcomes.

Background: Uric acid (UA) is the final product of purine metabolism and a marker of oxidative stress that may be involved in the pathophysiology of cardiovascular and thromboembolic disease. The aim of the current study is to investigate the potential value of UA to creatinine ratio (UA/Cr) as a diagnostic tool for the outcome of patients admitted with acute pulmonary embolism (PE) and the correlations with other parameters. Methods: We evaluated 116 patients who were admitted for PE in a respiratory medicine department. PE was confirmed with computed tomography pulmonary angiography. Outcomes evaluated were hospitalization duration, mortality or thrombolysis and a composite endpoint (defined as mortality or thrombolysis). Patients were assessed for PE severity with the PE Severity Index (PESI) and the European Society of Cardiology (ESC) 2019 risk stratification. Results: The median (interquartile range) UA/Cr level was 7.59 (6.3–9.3). UA/Cr was significantly associated with PESI (p < 0.001), simplified PESI (p = 0.019), and ESC 2019 risk stratification (p < 0.001). The area under the curve (AUC) for prediction of 30-day mortality by UA/Cr was 0.793 (95% CI: 0.667–0.918). UA/Cr levels ≥7.64 showed 87% specificity and 94% negative predictive value for mortality. In multivariable analysis UA/Cr was an independent predictor of mortality (HR (95% CI): 1.620 (1.245–2.108), p < 0.001) and composite outcome (HR (95% CI): 1.521 (1.211–1.908), p < 0.001). Patients with elevated UA/Cr levels (≥7.64) had longer hospitalization (median (IQR) 7 (5–11) vs. 6 (5–8) days, p = 0.006)), higher mortality (27.3% vs. 3.2%, p = 0.001) and worse composite endpoint (32.7% vs. 3.4%, p < 0.001). Conclusion: Serum UA/Cr ratio levels at the time of PE diagnosis are associated with disease severity and risk stratification, and may be a useful biomarker for the identification of patients at risk of adverse outcomes.

Two families with Birt-Hogg-Dubé syndrome:case report and literature review

Objective: To improve the awareness of Birt-Hogg-Dubé syndrome. Methods: We performed a retrospective analysis with two families of Birt-Hogg-Dubé syndrome (BHD syndrome) diagnosed in Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital from 2020 to 2021. Clinical manifestations, imaging features, diagnosis and gene detection results were summarized. Relative literatures were reviewed in Wanfang Database and PubMed from 2015 to 2021 by using the search terms of "BHD syndrome" "Birt-Hogg-Dubé" "Birt-Hogg-Dubé syndrome", respectively. Results: The probands of both families were female, aged 37 and 34 years respectively. The onset manifestation was pulmonary bullae combined with pneumothorax. Chest computed tomography (CT) imaging showed multiple pulmonary cysts in both lobes, and no skin lesions or renal tumors were found in either case. History of pneumothorax was present in Family 1 while absent in Family 2. The FLCN gene of the two probands and their relatives showed the same mutation site. Totally 12 Chinese literatures and 394 English literatures were retrieved, among which 96 reported lung involvement only. A total of 10 literatures about Chinese population were screened out from the English literatures, and 115 patients, 31 males and 84 females, were included. The incidence of spontaneous pneumothorax was 66.95% (77/115), while a family history of pneumothorax was 88.31%(68/77). The onset age of spontaneous pneumothorax was between 30 and 44 years. The most common mutation site of FLCN was c.1285dup. Conclusions: BHD syndrome in Asian population may only have lung involvement. Patients with pneumothorax and pulmonary cystic lesions should be inquired of the family history. We speculate that there are many underdiagnosed cases in clinical practice.

Inflammation markers in moderate and severe obstructive sleep apnea: the influence of sex.

Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder, with a negative impact on cardiovascular health. Different OSA symptoms and treatment response in males and females have been reported. The aim of this study was to investigate inflammatory markers inpatients with OSA and the relationshipof those markers to disease severity in male and female subjects. We considered consecutive subjects referred to the outpatient Sleep Disorder Service of the Respiratory Medicine Department, San Marino Hospital. We included patients with a diagnosis of moderate or severe OSAS and an age range of 45-80years. Concomitant inflammatory conditions were an exclusion criterion. A polygraphic study and a blood draw for inflammatory markers were performed for each subject. Of 110 subjects, 59 weremales. Severe OSA affected 72 subjects. We analyzed data through a 4-level categorical variable according to sex and OSA severity (moderate OSA, males; severe OSA, males; moderate OSA, females; severe OSA, females), which showed significant differences for interleukin-6 (IL-6) and C-reactive protein (CRP) levels. A significant difference in IL-6 levels with a significant ascending trend (p = 0.045) from females with moderate OSAS to males with severe OSAS emerged in our pairwise comparison for estimated marginal means. Also, a significant trend (p = 0.0001) for CRP levels from males with moderate OSAS to females with severe OSAS was shown. OSA and inflammation are interconnected, and both are associated with vascular diseases. Sex-related differences in OSA phenotypes may help the clinicians aim for a more personalized approach.

Temporal observation of endoscopic and histological findings of gastritis after administration of an immune checkpoint inhibitor: a case report

A 71-year-old Japanese man was treated with 200 mg of pembrolizumab for lung adenocarcinoma with multiple bone metastases at the Department of Respiratory Medicine of Kameda General Hospital. After 19 treatment courses, he complained of epigastric pain before meals. Upper gastrointestinal endoscopy showed multiple erosions in the gastric antrum, and antacids were administered at follow-up. After 27 treatment courses, the patient underwent another endoscopy because of anorexia. The erosions were enlarged and had increased from the gastric antrum to the greater curvature of the body. Histological biopsy showed lymphocytic infiltration with a predominance of CD8-positive T cells. The patient had previously been treated for Helicobacter pylori infection, and we suspected drug-induced gastritis due to the administration of immune checkpoint inhibitors in the course of the disease. Pembrolizumab was discontinued, and the patient’s symptoms gradually improved. Endoscopic examinations were performed 2, 5, and 9 months after discontinuation of pembrolizumab, and improvement in mucosal findings and decreased lymphocyte infiltration were confirmed each time. The patient has remained without any relapse of symptoms for more than 1 year after discontinuing treatment.

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BACKGROUND:Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis and is one of the leading cause of mortality worldwide. Presence of various psychiatric co-morbidities can have impact on treatment of tuberculosis and Identifying and treating them can increase cure rates of tuberculosis.AIM AND OBJECTIVES-The aim of the study is to assess the psychiatric co-morbidities and their relationship with socio-demographic variables in patients of pulmonary tuberculosis.MATERIAL AND METHODS-A total of 120 patients diagnosed with pulmonary tuberculosis from the department of respiratory medicine were assessed for the presence of psychiatric co-morbidity using Mini International Neuropsychiatry Inventory (MINI).RESULT-Overall psychiatric co-morbidities were found in 54 (45%) patients out of 120. The frequency of co-occurrence of different types of psychiatric disorders was as following: depression 22.5%, social phobia 9.2%, panic disorder 7.5%, obsessive compulsive disorder 5.8%, generalized anxiety disorder 4.2%, alcohol dependence 2.5%, suicidality 1.7%. Among socio-demographic parameters, marital status and educational level were associated with psychiatric co-morbidities in pulmonary tuberculosis patients. psychiatric co-morbidities were found to be more in singles and patients with lower educational level.CONCLUSION-Psychiatric comorbidities were found to be a common problem with pulmonary tuberculosis. The Results of this study are in line with many different research works both in India and abroad. A proper address of this issue is important for the management, better outcome and policy making in patients with pulmonary tuberculosis.