Department Of Respiratory Medicine Research Articles

Prediction of the Need for Niv in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Comparative Study Between Decaf And Modified Decaf Score

Background: Exacerbation of chronic obstructive pulmonary disease (COPD) leads to multiple hospital admissions, longer hospital stays, increased treatment costs as well as increased morbidity and mortality. Currently, no optimal scoring system exists that can predict need for NIV in patients with acute exacerbation of COPD. Accurate prognostic tool can help physicians to select the appropriate level of care and preparedness.To compare DECAF [(D) dyspnoea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) atrial fibrillation] and modified DECAF score [(D) dyspnoea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) frequency of hospital admission] in predicting the need for NIV in patients with acute exacerbation of chronic obstructive pulmonary disease. Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, NIDCH, Mohakhali, Dhaka from June 2021 to August 2022. A total of 91 patients with acute exacerbation of COPD were enrolled in this study. All patients were subjected to complete medical history taking, chest examination, dyspnoea assessment by extended modified Medical Research Council Dyspnoea (eMRCD), complete blood count, chest radiograph, ECG, and arterial blood gas analysis. Both DECAF and modified DECAF score were calculated and the need for NIV was documented. All collected data were analysed using appropriate statistical formula and SPSS programme. Results: Out of 91 patients, 20 patients (21.97%) required non-invasive ventilation. The area under the ROC curve of DECAF and modified DECAF score was 0.973 and 0.974 respectively in predicting the need for NIV. The sensitivity, specificity, PPV and NPV of DECAF score were 84.21%, 94.44%, 80.00% and 95.77% respectively at a cut off value of 3. The sensitivity, specificity, PPV and NPV of modified DECAF score were 84.52%, 100%, 100% and 96.51% respectively at a cut off value of 4 Conclusion: Both DECAF score and the modified DECAF score are practical and can be calculated easily using simple questions and routine investigations available during the initial admission. Both were good predictors, but modified DECAF was superior in predicting need for NIV in patients with acute exacerbation of COPD Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 208-209

A study of antibody response to Covid-19 infection

: The Coronavirus disease 2019 is a disease caused by the etiological agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was a newly identified β-coronavirus that had spread rapidly around the world, resulting in a very high number of infections and deaths, threatening public security, and placing a heavy burden on global healthcare systems and economy. The present study was done to study antibody response in COVID-19 infection.: The study was carried out in the Department of Respiratory Medicine, R.D. Gardi Medical College, Ujjain, India after approval by ethics committee. The post COVID-19 cases attending respiratory medicine OPD were included in the study.: The present study was conducted in 122 patients. The mean age of the patients was 51.20±14.21 years, median age was 54.5 years, the minimum age was 14 years and the maximum age was 80 years, the most number of COVID-19 infection cases was in the elderly age group of more than 50 years. The severity of disease was seen in those above 50 years of age (57.3%) with p>0.05. Among the severe cases mean age of the cases was 49±17 years, in moderate cases mean age 52±14 and among mild group of cases mean age was 51±15 years.In the present study there were 73.8% males and females were 26.2% Among COVID-19 cases who reported in the OPD the maximum that is 86 (>70%) patients had moderately severe disease, while severe cases were only about 14 %. Mild cases were 15.6%.In the present study RT-PCR were negative in 36(29.5%) as against 86 (70.5%) were confirmed cases of COVID-19 and among positive cases 40 % cases became negative between 6-10 daysAmong severe disease cases mean SARS COV2 antibody 650.06±240.47 was significantly higher as compare to moderate cases 461.49±331.41 and mild cases 404.11±240.47.: India has the world’s largest vaccination program. COVID-19 antibodies estimation are important tests carried out to determine the response of the body against COVID-19 infection.Our results show a significant association between SARS COV2 antibody and the severity of disease.

EFFECT OF PULMONARY REHABILITATION ON SLEEP QUALITY IN DIAGNOSED ILD PATIENTS

Aims And Objectives To evaluate the effect of pulmonary rehabilitation on sleep quality in patients with interstitial lung diseases using Pittsburgh Sleep Quality Index (PSQI) score. Materials And Methods The study was conducted in the Department of Respiratory Medicine, M.M. Institute of Medical Sciences and Research, Mullana. Patients with ILD who visited the Department of Respiratory Medicine were taken into consideration. Results The mean Global Pittsburgh Sleep Quality Index (PSQI) Score before pulmonary rehabilitation was 9.45 + 2.80, while after pulmonary rehabilitation was 7.45 + 3.64, meaning sleep quality improved. Conclusion From this study, it can be concluded that there is a high prevalence of poor sleep quality in patients with ILD referred for pulmonary rehabilitation and this is independently associated with increasing symptoms of sleepiness. Patients with ILDs achieve significant gains in exercise capacity regardless of disease severity. Pulmonary rehabilitation should be considered as a standard of care for patients with ILD.

Diagnostic value of SHOX2, RASSF1A gene methylation combined with CEA level detection in malignant pleural effusion

AimTo investigate the diagnostic value of combined detection of SHOX2 and RASSF1A gene methylation with carcinoembryonic antigen (CEA) level in diagnosing malignant pleural effusion.MethodsBetween March 2020 and December 2021, we enrolled 68 patients with pleural effusion admitted to the Department of Respiratory and critical care medicine of Foshan Second People's Hospital. The study group included 35 cases of malignant pleural effusion and 33 cases of benign pleural effusion. Methylation of the short homeobox 2 genes (SHOX2) and RAS-related region family 1A gene (RASSF1A) in pleural effusion samples were detected by real-time fluorescence quantitative PCR, and the level of carcinoembryonic antigen (CEA) in pleural effusion samples was detected by immune flow cytometry fluorescence quantitative chemiluminescence.ResultsSHOX2 or RASSF1A gene methylation was detected in 5 cases in the benign pleural effusion group and 25 patients in the malignant pleural effusion group. The positive rate of SHOX2 or RASSF1A gene methylation in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (71.4% vs. 15.2%, P < 0.01). Positive CEA (CEA > 5 ng/m) was detected in 1 case in the benign pleural effusion group and 26 patients in the malignant pleural effusion group. The CEA-positive rate in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (74.3% vs. 3%, P < 0.01). When SHOX2 and RASSF1A gene methylation was combined with CEA detection, 6 cases were positive in the benign pleural effusion group, and 31 patients were positive in the malignant pleural effusion group. The positive rate of combined detection in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (88.6% vs. 18.2%, P < 0.01). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden’s index of SHOX2, RASSF1A gene methylation combined with CEA in diagnosing malignant pleural effusion were 88.6%, 81.8%, 85.3%, 83.8%, 87.1% and 0.7 respectively.ConclusionThe combined detection of SHOX2 and RASSF1A gene methylation with CEA level in pleural effusion has a high diagnostic value for malignant pleural effusion.

Study on the characteristics of Aspergillus fumigatus-sensitized asthma and allergic bronchopulmonary aspergillosis

Objective: To investigate the clinical characteristics of Aspergillus fumigatus(A.f)-sensitized asthma and allergic bronchopulmonary aspergillosis (ABPA), which provides a foundation for the diagnosis and differential diagnosis of A.f-sensitized asthma and ABPA, as well as the prevention of ABPA. Methods: This was a single-center retrospective case-control study. Collected the clinical data of patients who visited the Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University from December 2018 to May 2022.A total of 122 patients were included, including 64 males (52.5%) and 58 females (47.5%).The age range was 3 to 89 years.The median age was 44 years.The average age was 41.8 years.The patients were divided into three groups (48 ABPA, 35 A.f-sensitized asthma and 39 HDM-sensitized asthma).Analyzed the differences and correlations among clinical indicators in the three groups, and evaluated the risk factors for the development of ABPA in A.f-sensitized asthma.For statistical analysis, metrological data was tested by t-test or Wilcoxon Mann-Whitney. Classification variables by chi-square test or Fisher's exact test. Pearson correlation analysis for normal distribution data.Spearman correlation analysis for skewed distribution data. Influencing factor analysis was performed using multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was made, the area under the ROC curve (AUC) was calculated, and the sensitivity and specificity of the model were evaluated. Results: Compared with patients with A.f-sensitized asthma, the fractional exhaled nitric oxide (FeNO) [75.00(52.00, 87.00)ppb vs. 40.00(32.00, 52.00)ppb], eosinophils% (EO%) [10.60(6.75, 13.05) vs. 4.10(1.20, 7.30)], eosinophils (EO) [1.50(1.07, 2.20)×109/L vs. 0.33(0.10, 0.54)×109/L], A.f-specific Immunoglobulin E (sIgE) [10.24(4.09, 22.88)KU/L vs. 1.13(0.53, 3.72) KU/L], and sIgE to total IgE(tIgE) ratio (sIgE/tIgE) [0.0049(0.0027, 0.0100) vs. 0.0008(0.0004, 0.0017)] were higher in ABPA patients, the differences were statistically significant (P<0.001). In all patients, tIgE was positively correlated with EO% (r=0.206, P<0.05) and EO (r=0.302, P<0.001). sIgE/tIgE was negatively correlated with one-second rate (FEV1/FVC%) (r=-0.256, P<0.01). The percentage of predicted forced vital capacity [FVC(%)] was negatively correlated with FeNO (r=-0.184, P<0.05).In the ABPA group, the percentage of predicted peak expiratory flow [PEF(%)] was negatively correlated with FeNO (r=-0.295, P<0.05). In the HDM-sensitized asthma group, FeNO was positively correlated with EO% (r=0.49, P<0.01) and EO (r=0.548, P<0.001).The results of logistic regression analysis showed that FeNO and EO were the influencing factors for the development of ABPA in A.f-sensitized asthma. ROC curve analysis results showed that A.f-sIgE (cut-off, 4.108; AUC=0.749;95%CI, 0.632-0.867), sIgE/tIgE(cut-off, 0.0026;AUC=0.749;95%CI, 0.631-0.868), FeNO(cut-off, 55.5;AUC=0.794; 95%CI, 0.687-0.900), EO% (cut-off, 8.70;AUC=0.806;95%CI, 0.709-0.903) and EO (cut-off, 0.815;AUC=0.865;95%CI, 0.779-0.950) had differential diagnostic value in A.f-sensitized asthma and ABPA.The combination of FeNO, EO and EO% had good diagnostic efficiency in differentiating A.f-sensitized asthma from ABPA, with a sensitivity of 91.4% and a specificity of 84.4%. Conclusion: Compared with patients with A.f-sensitized asthma, patients with ABPA have more severe eosinophil inflammation. The higher the FeNO and EO, the more likely A.f-sensitized asthma will develop into ABPA.sIgE/tIgE may have differential diagnostic value in A.f-sensitized asthma and ABPA.The combination of FeNO, EO and EO% has good diagnostic efficacy in differentiating A.f-sensitized asthma from ABPA.

Assessment of Serum Magnesium Levels In Patients With Acute Severe Bronchial Asthma Admitted in a Tertiary Care Hospital

Background: Hypomagnesaemia has been associated with diminished respiratory muscle power, which maintains the work of breathing. However, the effect of magnesium on asthma has yet to be examined in our country. Therefore, assessing the serum magnesium level in acute severe asthma patients in a tertiary-level hospital was the study’s objective. Methods: The study was a hospital-based descriptive cross-sectional study conducted at the Department of Medicine and Department of Respiratory Medicine in DMCH. Each patient performed serum magnesium ion (Mg2+) during admission with other necessary investigations. Results: Fifty-seven percent of participants had hypomagnesemia, and 43% of patients had normal magnesium levels. Mean serum magnesium was 1.57±0.22 mg/dl [range: 1.25-2.23 ng/dl]. Although a higher proportion of patients with severe attacks (64.8%) had hypomagnesemia than those who had moderate-severity attacks (47.8%), the difference is not statistically significant (p &gt;0.05). About 23% of patients stayed at the hospital for &gt;3 days; among them, 73.9% had hypomagnesemia. Hypomagnesaemia patients had higher odds of staying at the hospital for &gt;3 days, but the relation is not statistically significant (OR 2.62, 95% CI 0.93 -7.36, p &gt;0.05). Conclusion: Hypomagnesaemia is present in half of the patients with acute severe bronchial asthma and is not associated with the severity of the disease and duration of hospital stay. J Dhaka Med Coll. 2022; 31(1) : 114-119

Risk Factors of Readmission Within 90 Days for Chronic Obstructive Pulmonary Disease Patients with Frailty and Construction of an Early Warning Model.

This study aimed to explore the risk factors for readmission within 90 d in Chronic Obstructive Pulmonary Disease (COPD) patients with frailty and construct a clinical warning model. COPD patients with frailty hospitalized in the Department of Respiratory and Critical Care Medicine of Yixing Hospital, Affiliated to Jiangsu University, were retrospectively collected from January 1, 2020, to June 30, 2022. Patients were divided into readmission and control groups according to readmission within 90 d. The clinical data of the two groups were evaluated by univariate and multivariate logistic regression analyses to identify readmission risk factors within 90 d in COPD patients with frailty. Then, a risk quantitative early warning model was constructed. Finally, the model's prediction efficiency was evaluated, and external verification was carried out. The multivariate logistic regression analysis showed that BMI, number of hospitalizations in the past year ≥ 2, CCI, REFS, and 4MGS were independent risk factors for readmission within 90 d in COPD patients with frailty. The early warning model for these patients was established as follows: Logit (p) = -1.896 + (-0.166 × BMI) + (0.969 × number of hospitalizations in the past year ≥ 2) + (0.265 × CCI) + (0.405 × REFS) + (-3.209 × 4MGS), and presented an area under the ROC curve (AUC) of 0.744 [95% CI: 0.687-0.801]. The AUC of the external validation cohort was 0.737 (95% CI: 0.648-0.826), and the AUC of the LACE warning model was 0.657 (95% CI:0.552-0.762). The BMI, number of hospitalizations in the past year ≥ 2, CCI, REFS, and 4MGS were independent risk factors for readmission within 90 d in COPD patients with frailty. The early warning model presented a moderate predictive value for assessing the risk of readmission within 90 d in these patients.

TO STUDY CLINICORADIOLOGICAL PROFILE OF IDIOPATHIC PULMONARY FIBROSIS (IPF) PATIENTS

Background - The term "interstitial lung disease" (ILD), or diffuse parenchymal lung disease (DPLD), represents a group of about 200 distinct disorders. Idiopathic pulmonary brosis (IPF) is one of the most severe forms of IIP. This study aims to observe clinicoradiological prole of idiopathic pulmonary brosis patients. A cross-sectional observational study (inpatients and out Methods- patients) visiting the Department of Respiratory Medicine, Gandhi Medical College, Bhopal for the period of 18 months from November 2019 to April 2021, diagnosed to have Idiopathic Pulmonary Fibrosis (IPF) by HRCT who meet the inclusion and exclusion criteria. The incidence of IPF is higher in males as Resultcompared to females. It appears mainly between the fth and seventh decades of life ,the mean age of IPF was 58.86 ± 11.93, and the maximum number of patients came under the age of 51–60 years .In this study, breathlessness and cough were the predominant symptoms in denitive UIP. The severity of breathlessness is higher in denitive UIP. In our study every patient with IPF, we found to have an abnormal chest xray. Hence, chest xray should be the rst investigation in any suspected case of IPF. The commonest chest radiographic abnormality in patients with IPF is peripheral reticular opacity, most marked at the bases. In this study, the most common HRCT Chest ndings in IPF patients were reticulations, subpleural and basal involvement, and brosis. In this study, the most common pattern of idiopathi Conclusion- c pulmonary brosis was denitive UIP and most common age group was 51–60 years old and IPF reveals a male predominance. Clubbing was found in 39.4% of patient's maximum with denitive UIP (28.8%). On auscultation, the most common ndings are ne crackles and the most common ndings on HRCT are reticulations So, the nal diagnosis of IPF is a multidisciplinary approach. Further study is needed with a larger sample size to understand the disease in detail.

Effect of adjunct Vitamin D treatment in vitamin D deficient pulmonary tuberculosis patients: A randomized, double blind, active controlled clinical trial

BackgroundSince, Vitamin D [1α,25(OH)2D)] enhances antimicrobial activity of Innate immunity and modulate Adaptive immune responses, simultaneously, so it play a potential role for balanced immune activity against Mycobacterium tuberculosis and restricting tissue injuries within the TB patients.(Chun et al., 2011) 9 We aimed to determine the role of adjunct Vitamin D treatment on the outcome of pulmonary tuberculosis patients and evaluated the effect of Vitamin D administration on Differential Leucocyte Count, Erythrocyte Sedimentation Rate, serum Adenosine deaminase, serum C- reactive protein, Oxygen saturation (SpO2) and Body Weight in Vitamin D deficient pulmonary tuberculosis patients. MethodsWe conducted a prospective, interventional, randomized, double blind, parallel group, active controlled clinical trial. Newly diagnosed Vitamin D deficient pulmonary tuberculosis patients were randomly assigned to intervention group (received standard anti-tubercular treatment with adjunct Vitamin D3) and control group (received standard anti-tubercular treatment without adjunct Vitamin D3). Total four doses [each dose of 2.5 mg (100000 IU)] of Vitamin D3 were given, orally. First dose was given within 7 days of starting anti-tubercular treatment and second, third, fourth dose were given at 2, 4 and 6 weeks respectively. At the time of enrollment, we measured all baseline characteristics. During follow-up, we measured the study variables and monitored adverse events at 2, 4, 6, 8 and 12 weeks. Our safety parameter was serum corrected calcium level to assess the risk of hypercalcemia. ResultsTotal 130 pulmonary TB patients, 65 patients in each group, were analyzed. Our study results showed that decrease in Neutrophil count was statistically significant with small effect sizes at every time point of measurement and increase in Lymphocyte count was statistically significant with small and moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Decrease in erythrocyte sedimentation rate was statistically significant with small effect sizes at 6 and 8 week, decrease in serum adenosine deaminase and serum C- reactive protein was statistically significant with moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Increase in Oxygen saturation was statistically significant at 4 week with small effect size and increase in body weight was statistically significant with small effect sizes for intervention group than for control group. No case of hypercalcemia was reported. ConclusionOur findings suggest a potential role of adjunctive Vitamin D3 to accelerate resolution of inflammatory responses and improvement in clinical outcomes of pulmonary TB patients. Trial registrationThis trial is registered with Clinical Trials Registry - INDIA (http://ctri.nic.in) with CTRI Number - CTRI/2021/11/037914. Place of studyRoom Number 27, first floor out-patients department (OPD) and inpatient Wards, fourth floor, Department of Respiratory Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), INDIA.

Patient-Assessed Quality of Virtual Consultations as Follow-Up on Long-Term Oxygen Therapy for Patients With COPD.

Long-term oxygen therapy (LTOT) can increase survival time and relieve symptom burden in patients with COPD and chronic hypoxemia. The Department of Respiratory Medicine at Odense University Hospital invites patients with LTOT and COPD to the out-patient clinic for treatment evaluation every 6 months to regulate or terminate treatment and support patients' treatment adherence. The out-patient clinic, however, experiences many absences or cancellations from patients. For that reason, patients were offered virtual consultation as an alternative to physical attendance. This study was initiated to uncover reasons for absences and the patients' experiences of virtual consultation to promote a more patient-centered clinical practice for patients with COPD and LTOT. A qualitative study encompassing semi-structured interviews with 20 subjects was conducted in the winter of 2021. The subjects had tried or been given the opportunity of virtual consultation. Data were analyzed inspired by Kvale and Brinkmann focusing on the subject's perspectives on virtual consultation. The analysis resulted in 3 main themes: limitations and vulnerabilities, independence and quality of life, and personal strategies. Subjects expressed that everyday life with LTOT and COPD was characterized by limited resources in terms of energy, oxygen, and time. LTOT was perceived as a necessary means to maintain a sense of independence and quality of life. However, LTOT also meant additional limitations due to cumbersome equipment and feelings of isolation. Most subjects considered the virtual consultation to be oxygen-, energy-, and time-preserving, as it meant avoiding stressful transportation and handling of oxygen cylinders, COVID-19 exposure, waiting time, and not having to involve others for help. The subjects' perspective showed that follow-up on LTOT as a virtual consultation was considered a valuable offer. The chosen method was found to be relevant in uncovering subjects' attitudes toward clinical practice procedures.

A study of analysis on prevalence, serological marker and prognosis of tuberculosis in tertiary care hospital

BackgroundTuberculosis is an infectious disease responsible for a significant cause of ill health. According to the WHO global tuberculosis report 2021. 9.9 million cases fell sick with TB in 2020. Significantly, the prevalence of tuberculosis in India is 25%. ObjectiveTo analyze the prevalence of tuberculosis in the suburban areas of the metropolitan city in South India. To analyze the serological marker and prognosis of tuberculosis among males and females. To determine the importance of molecular testing - PCR confirmation on TB after AFB smear. MethodsA retrospective study to analyze 462 patients enrolled by the respiratory medicine department on suspecting pulmonary- 356 (M−264 & F-92) and extra-pulmonary-106 (M-73&F-33) patients and diagnosed Zhiel-Neelsen staining, Mantoux test, Chip-based RT-PCR test, Erythrocyte sedimentation rate, and analyzed serological test such as C-Reactive Protein, Chemiluminescence immune assay. Results23 patients were positive in Ziehl-Neelsen staining, 65 were positive in molecular True-Nat PCR test, Mantoux skin test induration in 10 patients, 98 TB Positive patients examined in the serological analysis, 1 & 3 patients reacted in HIV/HBsAg, and HBsAg test respectively, by chemiluminescence immunoassay, 8 PTB and 4 EPTB and 47 non-TB patients were positive in C-reactive protein, 46 TB and 94 non-TB patients detected abnormal values out of these 160 patients in ESR test. ConclusionThe Prevalence of tuberculosis is significantly rising, especially in the middle-aged population. The rapid molecular diagnostics to detect TB are highly sensitive and specific. Serological markers are essential for the analysis of disease prognosis and need to focus on the guidance of DOTS and RNTCP to End TB.

Risk factors associated with length of hospital stay and medical expenses in pulmonary abscess patients: retrospective study.

Pulmonary abscess carries a high mortality and requires long-term managements. A better understanding of the risk factors associated with the prolonged hospital stay and high medical expenses in these patients can improve the management strategy in individual patient and optimize the overall healthcare resources. We performed a retrospective study and reviewed the medical records on consecutive patients hospitalized at the Department of Respiratory Medicine of the General Hospital of Northern Theater Command, Shenyang, Liaoning, China, between January 1, 2015, and December 31, 2020. Demographics, comorbidity, clinical symptoms, laboratory tests, length of hospital stay, and medical expenses were recorded. Their relationships with the length of hospital stay and medical expenses in pulmonary abscess patients were analyzed. There were 190 patients with the pulmonary abscess and 12,189 patients without the pulmonary abscess. Compared with patients without the pulmonary abscess, patients with the pulmonary abscess had longer hospital stays (21.8 ± SD vs 12.8 ± SD, P < 0.01), In patients with the pulmonary abscess, the mean length of hospital stay was 5.3 days longer in male vs female patients (P = 0.025). Multivariate linear regression analyses showed that extrapulmonary disease and clinical symptoms were associated with the length of hospital stay and medical expenses, respectively. In addition, anemia was associated with both the length of hospital stay and medical expenses. Sex and hypoproteinemia were associated with the medical expenses. The mean length of hospital stay was longer in patients with the pulmonary abscess than those without the pulmonary abscess. The length of hospital stay and medical expense were associated with sex, clinical symptoms, extrapulmonary disease, and abnormal laboratory tests in patients with the pulmonary abscess.

Reasons for optimism in respiratory infections

Nottingham University Hospitals NHS Trust, University of Nottingham, Respiratory Medicine Department, Nottingham, UK Correspondence to Wei Shen Lim, Consultant Respiratory Physician & Honorary Professor of Respiratory Medicine, Nottingham University Hospitals NHS Trust, University of Nottingham, Respiratory Medicine Department, Nottingham NG5 1PB, UK. E-mail: [email protected]

COMPARISON OF INDIGENOUS SPUTUM TRUNAT WITH THE WIDELY IMPLEMENTED GENEXPERT IN DIAGNOSIS OF PULMONARY TB PATIENTS

Introduction: Eight countries reported the two thirds of the global burden, with India having 26% of the total cases in the world. Case detection remains the crucial factor in control of infection of Tuberculosis. Under RNTCP, three tests are incorporated for the diagnosis of TB (sputum smear microscopy, chest X -ray, and the CB-NAAT test). Both CB-NAAT and TruNAT, not only diagnose tuberculosis accurately, but also identify rifampicin resistance. Objectives: To compare sensitivity and specicity of indigenous TruNAT to the widely used CBNAAT test in detection of mycobacterium tuberculosis and presence of rifampicin resistance in suspected PTB patients. Methodology:This is a Diagnostic Validation Study done among 54 patients with ndings of pulmonary TB, attending OPD of Department of Respiratory Medicine and ENT. Data was obtained on presence of MTB and rifampicin resistance. Results: TruNAT positivity testing had a sensitivity, specicity, PPV value, NPV, and diagnostic accuracy of 98.11%, 100%, 100%, 50%, and 98.15% respectively. TruNAT for identication of rifampicin resistance had a sensitivity, specicity, PPV, NPV, and diagnostic accuracy of 98.11%, 100%, 100%, 50%, and 98.15% respectively. Conclusion: This study conrms that TruNAT has a good diagnostic accuracy rate with good sensitivity, specicity, positive predictive value, and diagnostic accuracy. With other additional advantages of speedy results and idea on rifampicin resistance (compared to sputum microscopy), lower cost, Portable, battery operated and not requiring temperature ceiling (Compared to CBNAAT) makes TruNAT, a comprehensive choice of diagnostic test and identication of Rifampicin resistance in TB cases.

The serum creatinine to cystatin C ratio predicts the risk of acute exacerbation of chronic obstructive pulmonary disease.

The purpose of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treatment is to minimize the negative impact of the current exacerbation and to prevent the development of subsequent events. Therefore, it is important to identify readily available serological indicators during hospital admission to assess the prognosis of patients with AECOPD. All patients hospitalized in a Department of Respiratory and Critical Care Medicine of tertiary care hospital between January 2021 and December 2021 for AECOPD were analyzed using univariate correlations and binary logistic regression analysis with 2 models for associations between demographic, clinical, and laboratory features and AECOPD risk. The ratio of creatinine to cystatin C (Cre/Cys C) ratio was significantly associated with age (r = -0.206, P = .000), weight (R = 0.331, P = .000), body mass index (BMI) (R = 0.133, P = .007), and forced vital capacity (FVC)% predicted (R = 0.130, P = .009). Multiple regression was performed to predict the Cre/Cys C ratio from age, weight, BMI, forced expiratory volume during 1 second/FVC ratio, and FVC% predicted FABP-4, with F (5, 405) = 24.571, P = .000, R2 = 0.233. The results showed that the most significant predictors of the Cre/Cys C ratio were age (P = .007), weight (P = .000), BMI (P = .000), and predicted forced expiratory volume during 1 second (P = .000). Multivariate analysis was performed to determine whether the Cre/Cys C ratio was a predictor of AECOPD risk. Model 1 showed that a low Cre/Cys C ratio was associated with an increased hospital length of stay (odds ratio: -0.114, 95% confidence interval: -0.061 to -0.005) and admission to the intensive care unit (odds ratio: 0.951, 95% confidence interval: 0.907-0.996). After adjustment for potential confounding factors, model 2 showed that a low Cre/Cys C ratio was not independently associated with AECOPD risk. The present study indicated that the Cre/Cys C ratio is an easy, cheap, repeatable, and promising tool that allows us to evaluate the risk of AECOPD using serum markers. A low Cre/Cys C ratio was associated with a prolonged hospital length of stay and admission to the intensive care unit in AECOPD patients. However, the associations were not independent.

Application of the Rome severity classification of COPD exacerbations in a real-world cohort of hospitalised patients.

Recently, the Rome classification was proposed in which objective and readily measurable variables were integrated to mark exacerbations of COPD (ECOPD) severity. The aim of this study is to investigate the distribution of a real-world patient population with hospitalised ECOPD according to the current classification across the newly proposed severity classification. We assume that a significant proportion of hospitalised patients will have a mild or moderate event. The Rome classification was applied to a cohort of 364 COPD patients hospitalised at the Department of Respiratory Medicine of Maastricht University Medical Center (MUMC) with a severe ECOPD. Differences in in-hospital, 30- and 90-day mortality were compared between mild, moderate and severe ECOPD according to the new classification. Moreover, data were stratified by the different severity classes and compared regarding general disease characteristics and clinical parameters. According to the Rome proposal, 52 (14.3%) patients had a mild ECOPD, 204 (56.0%) a moderate and 108 (29.7%) a severe ECOPD. In-hospital mortality in mild, moderate and severe events was 3.8%, 6.9% and 13.9%, respectively. Most clinical parameters indicated a significantly worse condition in patients classified in the severe group, compared to those in mild or moderate groups. Most of the events, traditionally all classified as severe because of the hospitalisation, were classified as moderate, while almost 15% were mild. The results of this study provide insight into the heterogeneity of hospitalised ECOPD and show that the newly proposed Rome criteria can differentiate between events with different short-term mortality rates.

The effects of simple graphical and mental visualization of lung sounds in teaching lung auscultation during clinical clerkship: A preliminary study.

The study aimed to evaluate visualization-based training's effects on lung auscultation during clinical clerkship (CC) in the Department of Respiratory Medicine on student skills and confidence. The study period was December 2020-November 2021. Overall, 65 students attended a lecture on lung auscultation featuring a simulator (Mr. Lung™). Among them, 35 (visualization group) received additional training wherein they were asked to mentally visualize lung sounds using a graphical visualized lung sounds diagram as an example. All students answered questions on their self-efficacy regarding lung auscultation before and after four weeks of CC. They also took a lung auscultation test with the simulator at the beginning of CC (pre-test) and on the last day of the third week (post-test) (maximum score: 25). We compared the answers in the questionnaire and the test scores between the visualization group and students who only attended the lecture (control group, n = 30). The Wilcoxon signed-rank test and analysis of covariance were used to compare the answers to the questionnaire about confidence in lung auscultation and the scores of the lung auscultation tests before and after the training. Confidence in auscultation of lung sounds significantly increased in both groups (five-point Likert scale, visualization group: pre-questionnaire median 1 [Interquartile range 1] to post-questionnaire 3 [1], p<0.001; control group: 2 [1] to 3 [1], p<0.001) and was significantly higher in the visualization than in the control group. Test scores increased in both groups (visualization group: pre-test 11 [2] to post-test 15 [4], p<0.001; control group: 11 [5] to 14 [4], p<0.001). However, there were no differences between both groups' pre and post-tests scores (p = 0.623). Visualizing lung sounds may increase medical students' confidence in their lung auscultation skills; this may reduce their resistance to lung auscultation and encourage the repeated auscultation necessary to further improve their long-term auscultation abilities.

Assessment of Adherence and Common Non-adherence Factors for Inhaled Medications in Asthma and Chronic Obstructive Pulmonary Disease (COPD) Patients

Abstract: Background: Inhaled medications are the cornerstone for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Adherence of inhaled medications can be influenced by many factors such as patient preferences, education and awareness. Therefore, it is fundamental to identify and address the factors that helps to improve adherence to inhaled medications. Hence, this study aims to assess the adherence and common non-adherence factors for inhaled medications in asthma and COPD patients. Materials and Methods: A prospective observational study was conducted at the department of respiratory medicine for 6 months in a tertiary care teaching hospital. A total of 150 patients who were diagnosed with asthma and COPD, and used inhaled medications were enrolled. Patients were interviewed and administered with Inhaled Medication Adherence Questionnaire (IMAQ). The identified factors for non-adherence were classified based on the five dimensions of adherence instrumented by the World Health Organization (WHO). Results: A total of 97/150 (64.7%) patients [asthma: 42 (64.2%) and COPD: 55 (68.7%)] were found non-adherent to inhaled medications. Between them, 54% were attributable to socioeconomic reasons, 38% were patient-related, 4.6% therapy-related and 3.3% healthcare system-related. According to the study results majority of patients showed non-adherence due to socioeconomic-related factors followed by patient-related factors. Conclusion: This study concluded that non-adherence to inhaled medication was high in asthma and COPD patients. Low economic status, social stigma, lack of knowledge, inappropriate usage technique and complexity of treatment were the most common factors influencing non-adherence to inhaled medications in asthma and COPD. Keywords: Asthma, Chronic obstructive pulmonary disease (COPD), Medication adherence, Medication adherence questionnaire, Non-adherence factors.

A Study on Assessment of Diagnostic Yield of Cell Block, FNAC and Invasive Biopsy in Lung Mass with Effusion

BACKGROUND: Accurate diagnosis of histological subtype is of paramount importance in case of lung malignancy as it leads to variation in treatment and assessment of prognosis. Hence the current study was done to establish the yields of different diagnostic techniques to perform tests in institutes with lesser equipment. METHODS: prospective observational study performed in 45 patients who presented with pleural effusions with an underlying lung parenchymal mass in department of respiratory medicine, GEMS&amp;H, Srikakulam, Andhra Pradesh from August 2021 to August 2022 were included in the current study. RESULTS: During the period of 12 months that is from August 2021 to August 2022 we came across 60 lung mass cases among them 45 presented along with pleural effusion. In them Cell block results were suggestive of malignant effusion in 13 out of 45 cases giving a yield of about 29% whereas the yield of FNAC (fine needle aspiration cytology) was 53% (24/45) giving a combined yield of 82% from cytological study. Biopsy was conclusive in all the cases with a yield of 100%. CONCLUSION: The combined yield of cell block and FNAC is high even though in the current study the efficacy of cell block and FNAC is lower to that of biopsy. Core needle biopsy is preferable to traditional cytology procedures, according to the current study, but in locations without the necessary equipment or when a patient is unfit for the treatment, the first line of inquiry should always be pleural fluid cell block and FNAC

Validity of diagnoses of respiratory diseases recorded in a Japanese administrative database

BackgroundValidating the information recorded in administrative databases is essential. However, no study has comprehensively validated the accuracy of Japanese Diagnosis Procedure Combination (DPC) data on various respiratory diseases. Therefore, this study aimed to evaluate the validity of diagnoses of respiratory diseases in the DPC database. MethodsWe conducted chart reviews of 400 patients hospitalized in the departments of respiratory medicine in two acute-care hospitals in Tokyo, between April 1, 2019 and March 31, 2021, and used them as reference standards. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DPC data on 25 respiratory diseases were determined. ResultsSensitivity ranged from 22.2% (aspiration pneumonia) to 100% (chronic eosinophilic pneumonia and malignant pleural mesothelioma) and was <50% for eight diseases, while specificity was >90% for all diseases. PPV ranged from 40.0% (aspiration pneumonia) to 100% (coronavirus disease 2019, bronchiectasis, chronic eosinophilic pneumonia, pulmonary hypertension, squamous cell carcinoma, small cell carcinoma, lung cancer of other histological types, and malignant pleural mesothelioma) and was >80% for 16 diseases. Except for chronic obstructive pulmonary disease (82.9%) and interstitial pneumonia (other than idiopathic pulmonary fibrosis) (85.4%), NPV was >90% for all diseases. These validity indices were similar in both hospitals. ConclusionsThe validity of diagnoses of respiratory diseases in the DPC database was high in general, thereby providing an important basis for future studies.