ABSTRACT
Background: Lung cancer is the most common cancer diagnosed worldwide. It is also the leading contributor to cancer-related mortality, resulting in around 1.38 million cancer deaths per year worldwide. The aim and objective of the study was to study the clinical presentations including paraneoplastic manifestations and metastatic effects of lung cancer and to identify reasons for delay in diagnosis of lung cancer. Methods:Hospital based observational study was conducted on 100 consecutive cases. Results: Mean age ofthe cases with lung cancer was 56.36 years and 30% of the cases. Male predominance was seen with 63% males to 37% females. Tobacco smoking was present in 59% cases while exposure to second hand smoke and biomass fuel was seen in 11% and 9% patients. Most common presenting symptoms were cough (22.21%), chest pain (16.13%), fever (14.37%), dyspnea (11%) and hemoptysis (5.22%). Most common type of lung tumor was Adenocarcinoma (53%) followed by Small cell carcinoma (22%) and Squamous cell carcinoma (19%). Mutation analysis by molecular testing where possible in 76.66% NSCLC cases and showed with RAS (26.19%), EGFR (23.8%), ALK1 (11.9%) and ROS (4.7%) mutation. Stage I and II of lung cancer was seen in 17% cases while stage III and IV was seen in 39% and 44% cases respectively. Conclusions:Present study shown tobacco smoking as the most common risk factor in the causation of lung cancer (59%) followed by passive smoking (11%) and biomass fuel exposure (9%). Mortality in the present study was 72% in 2 years of follow up and Median survival in the study was 11 months. We recommend high index of suspicion in the high-riskgroups as smokers and those with chronic respiratory diseases to avoid delay in diagnosis.
ABSTRACT
Sudden cardiac death is a common cause of mortality in patients with congestive heart failure. Asymptomatic ventricular arrhythmia has been attributed as the cause for increased overall mortality in such patients. We conducted a prospective randomised single-blind placebo-controlled trial with low-dose amiodarone to assess its efficacy in reducing mortality in severe congestive heart failure and its effect on exercise tolerance, left ventricular systolic function and ventricular ectopic activity. Patients were randomised to receive amiodarone (n = 36) 400 mg/day orally for one month followed by a maintenance dose of 200 mg/day, or to a standard treatment (n = 40) according to intention-to-treat principle. There were 10 cardiac deaths in the amiodarone-treated group and 16 in the control group. Significant improvement was noted in exercise time in the treadmill test (modified Bruce Protocol) among patients in the amiodarone-treated group while no such statistical difference was detectable in the placebo group. Side-effects in the amiodarone group included asymptomatic rise in hepatic enzymes (three-fold) in 6 percent and proarrhythmia in 3 percent of patients. Nausea was reported in one patient and rash in one. Though low-dose amiodarone proved to be an effective antiarrhythmic agent, it failed to live up to the expectation of improving sudden cardiac death in patients with severe chronic heart failure and asymptomatic ventricular ectopy.